Protein-energy wasting (PEW) is common in patients receiving maintenance hemodialysis and is associated with frailty, hospitalization, mortality, poorer quality of life, and reduced transplant readiness. While oral nutrition interventions remain first-line therapy, many patients cannot achieve adequate protein and energy intake because of anorexia, inflammation, dialysis-related catabolism, dietary restrictions, food insecurity, and limited access to specialized nutrition support. Intradialytic parenteral nutrition (IDPN) offers a practical, noninvasive method of delivering protein and calories during dialysis through the existing treatment circuit.