AGT and Insulin resistance: Notably, CKD per se, that is, even in the absence of diabetes, leads to insulin resistance; in fact, CKD is state of heightened inflammation with elevated levels of pro-inflammatory cytokines, and it is also associated with metabolic acidosis, excessive aldosterone and angiotensin II levels, accumulation of urea and uremic toxin, that is, all factors that promote insulin resistance [35].