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however, when recombinant IGF-1 is co-administrated with recombinant GH, circulating leptin levels are unexpectedly elevated, likely due to GH stimulatory effects on insulin production.87 Moreover, treatment with recombinant GH increases IGF-1 levels in patients undergoing hemodialysis with low protein intake, resulting in a positive nitrogen balance and suggesting an anabolic response, which may also contribute to increase the leptin levels.88 Of note, among the multiple factors, circulating IGF-1 concentration is strongly associated with loss of appetite in dialysis patients, a condition linked to poor clinical outcomes.89 However, very low IGF-1 levels have been associated with a higher mortality in CKD patients with poor muscle strength, whereas those with higher muscle strength showed improved survival despite of the reduced IGF-1 concentration.90 This suggests that muscle effects, potentially influenced by physical exercise habits or muscle-derived cytokines (myokines), may play a role in these outcomes

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Similar content being viewed by others Log in or create a free account to read this content Gain free access to this article, as well as selected content from this journal and more on nature.com or Abbreviations AEP: auditory evoked potential EEG: electroencephalograph GSH: glutathione NAC: N -acetyl-cysteine MMN: mismatch negativity NMDA: N -methyl-D-aspartate References Aydin S, Ozaras R, Uzun H, Belce A, Uslu E, Tahan V et al (2002)