Decreased eGFR may predispose to increased atherosclerosis with multiple pathogenic mechanisms involved, including deranged calcium/phosphate balance, secondary hyperparathyroidism, homocysteine, lipoprotein(a) metabolism, fluid overload, alterations in the angiotensin and endothelin systems, malnutrition, oxidative stress, insulin resistance, and alterations in inflammatory and coagulation pathways [36, 37]. Here, INS is linked to secondary hyperparathyroidism.