Other cross-sectional studies that showed a positive association between IS and GFR used surrogate markers, including fasting insulin and HOMA-IR to evaluate IS and involved older populations with lower mean GFR or established renal disease, with comorbidities such as hypertension and dyslipidaemia, and, in one study, with diabetes30, 31, 32, 33. Here, INS is linked to Hypertension.