A14-year-old boy with ESKD and hypertension, nutritional assessment done using WHO percentile growth chart, biochemical assessment and dietary assessment. He is a vegetarian and had suboptimal energy–789 kilocalories and 25 g of protein against the requirement of 2500 kilocalories and 45 g of protein. He falls in to the third percentile BMI in the WHO growth chart which showed severe PEW along with hypo albuminemia (serum albumin 2.4 g/dl). He was initially on MHD and switched over to home peritoneal dialysis due to uncontrolled hypertension. He required bilateral embolization of the kidneys for hypertension control. He is being prepared for kidney transplantation. Nutritional assessment showed protein energy wasting and sarcopenia. He urgently required nutritional intervention. Patient and family was educated about the nutrition and oral renal nutritional supplement was initiated by the nutritionist. With constant education and follow up, he gained dry weight and is improving nutritionally as shown in the BCM (Fig. 2.1).