OBJECTIVE A substantial number of patients with end-stage chronic renal failure (CRF) on dialysis have an inflammatory state that can be detected by elevation in serum levels of C-reactive protein (CRP). Hypoalbuminemia, which occurs in this population and always has been associated with malnutrition, seems to be a consequence of this inflammatory state. Data focusing on patients before dialysis treatment are lacking. METHODS Cross-sectional observational study. METHODS Outpatients from the Nephrology Division of the University Hospital. METHODS We investigated nutritional status and serum CRP in 27 patients (13 women) with advanced CRF on the occasion of their first visit. METHODS Nutritional status was evaluated by anthropometric and serum measurements. Energy and protein intake were evaluated using a 24-hour recall questionnaire. RESULTS Data are reported as mean +/- SD. Glomerular filtration rate was 18 +/- 5 mL/min. Anthropometric measurements showed normal body mass index in 75% of the patients, whereas the remaining patients were overweight; fat store was depleted in 60% of the patients. Serum albumin was 4.4 +/- 0.5 mg/dL and CRP was 0.47 +/- 0.63 mg/dL. Protein ingestion was 1.04 +/- 0.24 g/kg/d, and energy intake was 23.57 +/- 7.8 kcal/kg/d. CONCLUSIONS Patients with advanced CRF without specific treatment, evaluated for the first time, showed fat store depletion. This alteration was not associated with inflammation or with visceral protein loss, but with low energy intake. These results support the idea that this population should be followed up by specialists from the early stage of CRF to prevent malnutrition.