Inclusion Criteria:  Patients with end-stage chronic kidney disease older than 18 years undergoing routine hemodialysis treatment for at least 3 months having 3 hemodialysis sessions literate volunteered to participate in the study  Exclusion Criteria:  Patients with acute renal failure previously diagnosed with liver failure and/or malignancy  ,patients with New York Heart Society class 3-4 heart failure a history of kidney transplantation