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