INS and diabetes mellitus: Although the underlying mechanisms need to be elucidated, it appears that dysregulation of cytokines, intracellular oxidative stress, suppression of insulin downstream signaling, modulation of incretins, and pancreatic β-cell dysfunction are contributing factors21–23.In the present study, multivariate logistic regression analysis revealed that age >60 years, female gender, diabetes, lower TBIL, higher triglycerides, and higher total cholesterol were significant independent risk factors associated with the development of CKD, and these findings were consistent with other studies24,25.