Small studies of children with CKD stages 2 to 4 or on dialysis therapy have shown rates of hyperinsulinemia as high as 33% and rates of abnormal insulin resistance (measured by increased Homeostasis Model Assessment for Insulin Resistance) in up to 16% of patients, indicating that abnormalities in insulin and glucose metabolism may be present earlier [28, 29]. This evidence concerns the gene INS and Insulin resistance.