It has been generally understood that there is a progressive loss of LBM, muscle wasting and risk of malnutrition as CKD worsens (towards kidney failure) which is thought to be particularly linked to uremia, acidosis, inhibition of normal insulin-IGF-1 anabolic signalling pathways within skeletal muscle and activation of proteolytic systems [12,20]. Here, IGF1 is linked to nutritional deficiency disease.