This study was performed to investigate the serum zinc (Zn), plasma ghrelin, leptin levels and nutritional status, and to evaluate the potential association between malnutrition and these investigated parameters in malnourished hemodialysis (HD) patients. Fifteen malnourished HD patients, aged 42.9 +/- 2.11 years, who underwent the HD for 46.44 +/- 7.1 months and 15 healthy volunteers, aged 41.0 +/- 2.17 years, were included in this study. The nutritional status of the subjects was determined by the subjective global assessment (SGA). Anthropometric measurements were taken by bioelectrical impedance after HD. Blood samples were collected for the analysis of zinc (Zn), ghrelin, leptin, and selected blood parameters. The HD patients consumed less energy and nutrients than controls. In HD patients, body weight, body mass index (BMI) (p < 0.001), basal metabolic rate (BMR), body fat, lean body mass (LBM), serum Zn, copper (Cu) (p < 0.05), sodium (Na) (p < 0.01), glucose (p < 0.05), albumin (p < 0.01), total cholesterol (p < 0.001), and ghrelin (p < 0.05) were lower whereas body water ratio (p < 0.001), serum potassium (K) (p < 0.01), inorganic phosphorous (Pi), blood urea nitrogen, creatinine (p < 0.001), and plasma insulin (p < 0.05) levels were higher than the controls. No difference existed between HD patients and controls regarding plasma leptin levels. There were positive correlations for body weight-fasting glucose and body weight-leptin (p < 0.05), body weight-BMI and body weight-LBM (p < 0.01); body fat-leptin (p < 0.05); BMI-fasting glucose, BMI-leptin, and BMI-body fat (p < 0.05); albumin-hemoglobin and albumin-insulin (p < 0.05). Negative correlation was found for SGA score-ghrelin (p < 0.05). Malnutrition in HD patients may result from inadequate energy and nutrient intake and low Zn and ghrelin levels. Zinc supplementation to the diets of HD patients may be of value to prevent the malnutrition.