ALB and malnutrition: Second, a protein-restricted diet has been recommended for pre-dialysis CKD patients to prevent exacerbation of renal dysfunction, though that might be a risk factor for malnutrition and sarcopenia [9], which is supported by the findings showing the beneficial effects of a high-protein diet or amino acid supplementation on nutritional state, as assessed by improved serum albumin and various nutritional markers [10].