End-stage renal disease patients treated with hemodialysis are characterized by a special diet, increased oxidative stress, cardiovascular morbidity and mortality, as well as many other complications such as inflammation-malnutrition syndrome, muscle cramps, and anemia. Worldwide efforts are focused on reducing hemodialysis complications to increase survival in these patients. In vitro and in vivo studies proved that vitamin E has many beneficial effects such as: decreases reactive oxygen

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... s synthesis, improves antioxidant defense system, inhibits lipids peroxidation and reduces atherosclerosis, and ameliorates anemia treatment. Mechanisms of action are complex and not fully understood. However, there are particularities in regards of vitamin E intake, metabolism, and clearance in patients treated with hemodialysis. Supplementation of vitamin E in these patients has been intensively studied, and it is still under debate. Oral administration and vitamin E-coated membranes for dialysis have been tried. Clinical practice guidelines tried to underline when and how much vitamin E to be given to be safe and costbeneficial. The current chapter aims to synthesize all these issues.