Objective To examine the prevalence of and risk factors for malnutrition at the start of specialized predialysis care. Design The present analysis was performed on cross-sectional data collected at inclusion in the study. The study included 25 outpatient clinics delivering specialized predialysis care in the Netherlands. Subjects Three hundred seventy-six incident patients with advanced chronic kidney disease attending one of the participating outpatient clinics. Main Outcome Measure Subjective global assessment (SGA) of nutritional status. Results At the start of specialized predialysis care, 11% of patients suffer from moderate protein–energy wasting as measured by SGA. Independent risk factors are age >75 years (Odds ratio [OR], 3.88 [1.74-8.66]), female gender (OR, 2.95 [1.37-6.32]), and having a body mass index 2 (OR, 2.56 [1.19-5.49]). Estimated glomerular filtration rate was not significantly associated with SGA (OR, 1.63 [0.76-3.48]). Conclusions Eleven percent of patients started on specialized predialysis care suffer from moderate protein–energy wasting; risk factors are age >75 years, female gender, and BMI 2 .