DaVita Assessment of Nutritional Supplement Effects (DANSE)

Inclusion criteria

• Patient is at least 18 years of age
• Patient has been on hemodialysis >6 months at the time of study entry
• Patient dialyzes three times a week
• Patient agrees to try ONS for the 6 month study period.
• Patient has demonstrated an albumin <3.5 g/dL on last available lab drawn in dialysis facility
• Patient is adequately dialyzed with a Kt/V > 1.4 at the most recent lab draw
• Patient is capable of reading and comprehending Informed Consent Form and provides written informed consent

Exclusion criteria

• Peritoneal dialysis
• Dysphagia
• Aspiration risk
• Difficulty swallowing
• History of symptomatic intolerance to food or liquid consumption during dialysis treatments
• Terminal illnesses with life expectancy <6 months, e.g. stage IV cancer or full blown AIDS
• Concurrent appetite stimulants
• Use of IDPN in last 3 months
• Inability to follow and to comply with the instructions and guidelines
• Severe liver disease defined as most recent SGOT > 78
• Active malignancy (other than skin)
• Major surgery within previous 6 months or anticipated during the 90-day study period
• Females who are pregnant or are breast-feeding
• Considered clinically unstable by the treating nephrologists
• Noncompliance with dialysis treatments ( Missed > 2 treatments in prior month due to noncompliance)
• Extended or frequent hospitalizations defined as hospitalization of longer than 15 days with discharge within the last 30 days or greater than 3 admissions within the last 30 days
• Regular supplement use defined as consumption of > 7 servings of a commercially available kcal/ protein supplement in the prior month
• Any clinically significant medical disease or condition that, in the investigator's opinion, may interfere with protocol adherence or a patient's ability to give informed consent