PTH and Insulin resistance: There are many potential risk factors other than IL-18 for LV systolic dysfunction in hemodialysis patients, such as hypertension, hyperlipidemia, endothelial dysfunction, oxidative stress, insulin resistance, hemodialysis-related myocardial stunning, intra-dialytic hypotension, hypervolemia and positive sodium balance, high oxidative stress status, abnormalities of mineral metabolism with low 1,25-dihydroxyvitamin D and high parathyroid hormone levels, and high indoxyl sulfate level [41].