A web-based cross-country survey of renal registered dietitians (RRDs) was launched. It was used to assess whether or not their clinical practice in identifying and treating protein-energy malnutrition (PEM) in adults with end-stage renal disease (ESRD) and dialysis was based on current nutrition practice guidelines (NPGs). The survey included questions on strategies, timelines, and markers used for the identification and treatment of PEM. Fifty-nine RRDs responded (21%). Sixty-seven percent did not base clinical practice on NPGs, while 33% indicated they followed the guidelines. Of those who followed guidelines, 76% use the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative nutrition guidelines. Strategies used to identify and treat PEM were not related to duration of RRD experience in nephrology, but were significantly different between guidelines users and non-users. Guideline users commonly used key nutrition treatment strategies that included enteral/parenteral nutrition and medication therapy. The clinical practice of RRD is typically based on expert opinion/consensus, rather than on evidence-based practice guidelines (EBPG). It remains unclear if differences in RRDs' adoption of clinical guidelines influences patient outcomes, particularly in the treatment of PEM. Up-to-date EBPG need to be developed for the identification and treatment of PEM in patients with ESRD.