Hypoalbuminemia is a surrogate of malnutrition in patients with end-stage renal disease undergoing chronic dialysis and commonly improves with prescription of adequate nutrition and dialysis. Nevertheless, some patients remain hypoalbuminemic for poorly understood reasons. We tested the hypotheses that chronic dialysis patients who remain hypoalbuminemic despite prescription of adequate nutrition and dialysis (1) have delayed gastric emptying, and (2) that prokinetic agents will increase plasma albumin (Palb) levels in patients with delayed gastric emptying. We retrospectively identified 99 of 343 hemodialysis and peritoneal dialysis patients with hypoalbuminuria (Palb< 3.5 mg/dL) and studied those who did not (hypoalbuminemic, n =15) and did (normoalbuminemic, n = 15) increase their Palblevels over the subsequent 6 months and met inclusion and exclusion criteria. Gastrointestinal symptom scores determined by an administered questionnaire were not different in hypoalbuminemic and normoalbuminemic patients. Conversely, the half-time (T1/2) for radionuclide gastric emptying was longer in hypoalbuminemic than normoalbuminemic patients (74.5 ± 7.4 versus 46.7 ± 4.6 minutes; P< 0.004). Hypoalbuminemic patients were prescribed prokinetics and followed prospectively for 6 months, during which time gastric T1/2decreased to 53.9 ± 3.3 minutes (P< 0.01 versus initial) and Palbincreased from 3.1 ± 0.2 to 3.5 ± 0.2 mg/dL (P< 0.004). The net increase in Palblevel correlated with the net decrease in gastric T1/2(r2= 0.4; P< 0.04) by linear regression. The data show that some persistently hypoalbuminemic chronic dialysis patients have poor gastric emptying and increase their Palblevels in response to prokinetic agents.