Multimodal Therapeutic Approach in Undernourished Maintenance Hemodialysis Patients (AMERICANO)

Inclusion Criteria: * Hemodialysis patient since at least 6 month * Patient aged 18 years or older * Written consent to participate in the study * No acute infection or hospitalization * Opinion of Cardiologist saying there is no known evidence against the evaluation of the maximum exercise capacity * Protein-energy wasting diagnosed if at least two of this characteristics are present * Serum albumin \<3.8 g per 100 ml (Bromcresol Green) * Serum prealbumin (transthyretin) \<30mg per 100 ml * Reduce body mass (BMI \<23) * Unintentional 10% weight loss over 6 months * Lean body mass index \< 10th percentile Exclusion Criteria: * Presence of comorbidity which compromising the survival within 6 month * Unintentional low DEI \<20 kcal kg\_1 day\_1 * HIV or HCV positive * History of hormone dependent cancer * Suspected or confirmed prostate cancer or breast carcinoma * Known hypersensitivity for testosterone * Presence or history of hepatic tumor * Inability to follow the rehabilitation program * Inadequate dialysis dosage (\<12 hours / week or Kt/V index\< 1,2) Pregnant or planning pregnancy and lactating women during study period * Adult patient protected by law * Patient who don't sign his informed consent