An estimated 85% of United States adults with chronic kidney disease, stage 5, were on hemodialysis (HD) during 2019 compared to the 11% on peritoneal dialysis.1 Even though the percentage of individuals on HD had declined slightly since 2016 at 90%, HD is still the most performed treatment. The HD process itself is considered a taxing process as one expends about 200 kcals and loses 6–8 g of amino acids and is arguably the most limited in their dietary choices.2-5 Thus, protein-energy wasting (PEW) often occurs which can contribute to cardiac issues and ultimately death.