The common occurrence of a wasting syndrome in patients with end-stage renal disease (ESRD) on haemodialysis indicates the need for nutritional management. Pancreatic hypofunction has been documented in these patients, and is suggested as a contributory factor to the wasting of ESRD. The patient presented illustrates the presence of pancreatic disease, and details his management. The advantages of pancreatic supplementation in improving nutritional status in ESRD are considered.