A 78-year-old female with a previous diagnosis of type 2 diabetes mellitus attended to the emergency room after presenting dyspnea of small efforts, chest pain and generalized edema of three days of evolution, as well as a history of decreased food intake from approximately 8 months related to depressive disorder. Upon admission on 12/30/2020, laboratories report serum creatinine 6.70mg/dL (glomerular filtration= 7.2mL/min/1.73m2 by CKD-EPI), urea106.30 mg/dL, potassium 8.01mmol/L, glucose 297 mg/dL; electrocardiographic findings of peaked T waves, widened QRS and supraventricular tachycardia. Admission weight= 44Kg, height= 1.52 m, BMI=19.04 Kg/m2. Nutritional risk was assessed through Malnutrition Universal Screening Tool (MUST) which scored 4 (high risk of malnutrition). The patient was admitted to the hospital with the following diagnoses: Uncontrolled type 2 diabetes mellitus, acute kidney injury KDIGO 3, severe hyperkalemia and protein energy wasting (PEW). Right jugular tunneled vascular access was placed and an urgent hemodialysis session was scheduled at the same day. After three hemodialysis sessions control laboratories were carried out: serum creatinine 3.34mg/dL, urea 53 mg/dL, albumin3.7 mg/dL, potassium4.69 mmol/L. As the patient showed improvement in clinical and biochemical parameters, she was discharged from hospital, and she continued treatment with outpatient hemodialysis two sessions per week. Nutritional counsel was given. During the follow-up, a tendency to decrease in weight prior to hemodialysis sessions was detected, the relatives reported that the patient persisted with low dietary intake (<10kcal /kg ideal weight/day) still related to depressive disorder, so that nutritional status was assessed again founding severe protein energy wasting thus, we decided to start with intradialytic parenteral nutrition (IDPN) on 01/29/2021 in order to increase caloric-protein intake and improve clinical prognosis. It was started with standard emulsion for infusion of 1100 Kcal/986 ml placed in a venous chamber with infusion pump, with good tolerance from the first occasion and continues to be administered during the following 8 sessions. During this period there were no episodes of catheter-related bacteremia, infections or complications associated with treatment; the infusion of parenteral emulsion did not interrupt or complicate the proper functioning of any hemodialysis session. The patient reported a constant increase in her dietary intake evidenced by a desirable increase in dry weight, which is why IDPN was suspended and dialysis doses were progressively decreased until her withdrawal. The patient continues to be followed up and by the last assessment (08/11/2021) her weight increased to 57 Kg without data of water overload, serum creatinine decreased to 1.07mg/dL, urea 47.60mg/dL, and BUN 22.2 mg/dL. The lessons learned from this case are: