【Objectives】We investigated significant factors for long-term survival of dialysis patients. 【Subjects】Twenty-five patients (14 males and 11 females) on chronic dialysis for≥21 years (Group L) and 83 patients (58 males and 25 females) on dialysis for periods less than 20 years (Group S) at our hospital were enrolled. 【Methods】We compared nutritional indexes between Group L and Group S. We also assessed the dietary intake of Group L by using the Food Frequency Questionnaire Based on Food Groups. Furthermore, we investigated changes in the nutritional indexes over the past 20 years in Group L. 【Results】Serum albumin (Alb), creatinine generation rate (%CGR), body fat, muscle mass, blood urea nitrogen (BUN), normal protein catabolic rate (nPCR), serum inorganic phosphate (iP), and serum kalium (K) did not differ between Group L and Group S. The body mass index (BMI) of Group L was 20.1 [17.7-21.7] kg/m² and 40% of patients in Group L were lean (BMI<18.5 kg/m²). BMI of Group L remained unchanged for over 20 years, although muscle mass decreased slightly. Dietary intake of Group L largely conformed to the 2014 dietary recommendations for chronic kidney disease. 【Conclusion】To achieve long-term survival, it is important for hemodialysis patients to maintain a constant BMI and good nutritional status.