Hemodialysis increases protein breakdown in the body, but the reasons behind it are complex. While whole-body studies show reduced protein synthesis, regional muscle studies reveal increased muscle protein breakdown. This discrepancy is due to the different ways muscles and the liver handle amino acids during hemodialysis. The liver uses amino acids from muscles to make new proteins, leading to a somatic to visceral recycling process. Despite the catabolic nature of hemodialysis, providing extra nutrition during treatment may help reduce its negative effects on protein balance.