Protein-energy wasting is strongly related to mortality in CKD patients.12 A 10-year cohort study in 206 hemodialysis patients showed that serum albumin level was a stronger predictor of mortality, more than inflammatory markers or intima-media thickness of the common carotid artery.13 In CKD population, surrogates of over-nutrition, for instance obesity or hyperlipidemia, seem to be associated with increased survival; this phenomenon is now acknowledged as 'reverse epidemiology'.14 This evidence concerns the gene ALB and chronic kidney disease.