ALB and nutritional deficiency disease: In patients with CKD, serum albumin lacks sensitivity and specificity as it is influenced by non-nutritional factors, such as fluid overload in dialysis patients, protein loss in urine and dialysate, inflammation, and infection [17] Abraham et al. [9] noted that PEW affects 40% of children with CKD, with MUAC serving as a marker for this type of malnutrition.