Impact of Providing High Protein Bar to Dialysis Patients With Low Serum Albumin

Inclusion Criteria: * Subjects with ESRD undergoing center hemodialysis or peritoneal dialysis for more than 90 days. * 18 years of age or older. * Must have a reasonable expectation of remaining on treatment for at least 3 months. * Must have an average serum albumin of \<3.5 g/dL over the three months prior to entry into the study. * Must be able to understand and sign the informed consent. * Must be willing and able to participate in nutrition interviews for determination of nutrient intake from conventional foods. Exclusion Criteria: * Allergy to protein, milk, nuts or wheat. * Documented ongoing acute infection or inflammatory process including treatment with antibiotics within a two week time of study entry. * Severe acidosis defined as pre-dialysis serum bicarbonate levels of \<15 mEq/L. * Presence of conditions that would affect normal response to repletion of protein and calories, such as gastrointestinal disorders including inflammatory bowel disease. * Hospitalization for an infectious condition within 4 weeks prior to study entry. * Planned surgery within the three month study period including planned kidney transplantation.