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Overall, the mean levels of achieved systolic BP and blood glucose (BG) over 24 h, and proportions achieving the targets for systolic BP and BG, were identified as significant mediators with effects of 8.9% (95%CI 4.8%-20%), 7.0% (95%CI 1.1%-17%), 4.0% (95%CI 1.2%-14%), and 7.6% (2.2%-15%), respectively

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however, this response was blunted compared to normal subjects, despite higher plasma IGF-1 concentrations, indicating partial resistance in advanced CKD.67 This reduced response is likely due to a decrease in the distribution and shortened half-life of the IGF-1 in dialysis patients.68 Furthermore, resistance to the GH-mediated bioactive IGF-1 stimulation has been demonstrated in non-diabetic hemodialysis patients, suggesting the presence of additional inhibitory mechanisms.69 In predialysis patients, increased production of IGFBPs has been observed, which may bind free IGF-1 and contribute to the attenuation of its renal effects.70 Therefore, as previously mentioned, elevated levels of renal IGFBPs in conditions of renal insufficiency may act as inhibitors of IGF-1 contributing to resistance in the proximal tubular cells.4 On the other hand, the renal anabolic actions of IGF-1 can be detrimental in the context of polycystic kidney disease (PKD), as it promotes renal cell proliferation and kidney enlargement

PLoS One 11 (8), e0161208

The proposed mechanism involves accumulated effect over the course rather than peak concentrations

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