ALB and nutritional deficiency disease: CKD has strongest death risk factor compared to other condition due to protein-energy wasting, including a relatively low serum albumin and fat or muscle wasting.5 A poor pre-dialysis nutritional status increases morbidity and mortality after initiation of renal replacement therapy.6 Studies on CKD revealed evidence of malnutrition/wasting problem in 18–75%.7–8 The signs of malnutrition reported in 23–76% in haemodialysis and 1850% in peritoneal dialysis patients.9, 12