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Taste impairment is prevalent among patients with end-stage renal disease and may compromise nutritional status. There have been no studies examining altered taste perception and nutritional outcomes. We performed a post-hoc analysis of data from the HEMO Study (n=1745). Taste perception was assessed at baseline and then updated annually. Time-updated linear and logistic regression models were used to examine the nutritional impact of altered taste perception and to evaluate predictors of altered taste perception. At baseline, 34.6% reported altered taste perception, which was associated with poorer nutritional indices. On longitudinal analysis, altered taste perception was independently associated with a persistently greater need for nutritional supplementation and subsequent reductions in serum albumin (-0.03 g/dL; p=0.02), serum creatinine (-0.22 mg/dL; p=0.009), normalized protein catabolic rate (-0.05; p < 0.001), protein intake (-0.04= g/kg/day; p=0.006), sodium intake (-90 mg/day; p=0.02), and mid–arm muscle circumference (-0.29 cm; p=0.05). Among prevalent hemodialysis patients, altered taste perception was found to be associated with poorer indices of nutritional status at baseline as well as subsequent decline in nutritional indices over time