Long-term Muscle Synthetic Effects of Intradialytic Parenteral Nutrition in Chronic Hemodialysis Patients

Inclusion Criteria: * Age above 18 years * Receiving HD treatment over 3 months * Receiving HD treatment 3 times per week for at least 4 hours per session * 24-hour urine production \< 100 mL * Adequate dialysis dose (eKt/V over 1.2) * AV fistula with blood flow (measured invasively or by Doppler ultrasound) over 750 mL/min Exclusion Criteria: * Occurrence of intradialytic hypotension in the last month, defined by systolic blood pressure \< 90 mm Hg combined with a nursing intervention * Hospitalization \< 3 months before inclusion * Active infection or inflammation at randomization * Use of oral or intravenous corticosteroids * Incapacitation * Patients who are not expected to be able to complete the study protocol (e.g., due to a planned kidney transplantation within the planned study time frame) * Pregnancy * Use of oral anticoagulants or antiplatelet agents that cannot be safely stopped during the study * Diabetes mellitus * AV fistula with recirculation