The Ottawa Inner City Health Project (ICHP) is a shelter-based health project for homeless individuals with complex health needs. The project includes shelter-based care units and a total of 122 beds, allowing homeless patients to live in-shelter; it employs support workers, nurses and a doctor to help patients manage medications, transportation, diet and hygiene.^11-13 We present and characterize a case series of homeless persons with chronic and end-stage renal disease, some of whom were cared for at the ICHP. Specific challenges in caring for this population are identified, with proposed management solutions.