Background Intradialytic parenteral nutrition (IDPN) is used infrequently to correct hypoalbuminemia in maintenance hemodialysis (MHD) patients. We hypothesized that the severity of baseline hypoalbuminemia correlates with the success rate of IDPN therapy in MHD patients. Methods In a prospective and contemporary cohort of 196 hypoalbuminemic MHD patients who received IDPN through Pentec Health (Boothwyn, PA), predictors of IDPN response were examined using multivariate logistic regression. Results Of 196 hypoalbuminemic MHD patients, 134 had severe hypoalbuminemia, defined as a baseline serum albumin level of less than 3.0 g/dL. The average period of IDPN therapy was 5.8 ± 2.4 months, S.D. The baseline level of serum albumin was lower in MHD patients who responded to IDPN (2.68 ± 0.47 g/dL, S.D.). A multivariate logistic regression analysis adjusted the associations for age, gender, diabetes, and IDPN time. The presence of severe hypoalbuminemia (serum albumin, <3.0 g/dL) at baseline was associated with a 2.5 times higher chance of responding to IDPN (95% confidence interval, 1.3 to 4.9; P = .006). The same severe hypoalbuminemia was associated with a 3.5 times increased likelihood of serum albumin correction by at least 0.5 g/dL (95% confidence interval, 1.8 to 6.8; P < .001). Conclusions Improvement of hypoalbuminemia occurs in most hypoalbuminemic MHD patients who receive IDPN therapy. The likelihood and magnitude of the response to IDPN are associated with the severity of baseline hypoalbuminemia. These associations need to be verified in controlled trials.