Our findings of reduced daily physical activity and physical performance may be particularly relevant because we studied an apparently healthier subgroup of MHD patients. This would suggest that renal failure and possibly, treatment regimens for renal failure per se may reduce daily physical activity and physical performance. Evidence that we studied healthier MHD patients includes the following: (1) Our inclusion/exclusion criteria precluded many comorbid conditions and stipulated that patients were not recently hospitalized, except for vascular access repair, and were able to perform the 6-MWT. (2) The patients’ serum albumin averaged 4.1 g/dL, which was the same as our normal control values and substantially higher than is reported in large epidemiological studies of MHD patients [43]. (3) Their BMI, LBM, percent body fat, and body weight were within the healthy range (Table 1). (4) Patients’ normalized protein nitrogen appearance (nPNA) was 1.10 ± 0.26 g protein/kg/day, which is greater than that reported for most MHD patients [27–29]. nPNA somewhat underestimates the daily dietary protein intake [44], and this value is only slightly lower or not different from protein intake recommended for MHD patients by K/DOQI and other expert workgroups [45, 46]. Moreover, MHD patients who describe good appetite demonstrate less inflammation and greater survival [47]. (5) The mean Charlson Comorbidity Index value of the 72 MHD patients was 5.7 ± 2.7 with a median value of 5, which is not high for dialysis patients [19, 48, 49]. (6) Daily physical activity and physical performance in our non-diabetic MHD patients, when analyzed separately, are still substantially and significantly decreased compared to normal adults (unpublished data).