LEP and Insulin resistance: Previous research have pointed out that patients with chronic kidney disease often suffer from metabolic acidosis, which may lead to increase in protein catabolism, decrease in protein synthesis, insulin resistance, chronic inflammation, decrease in serum leptin concentration that may cause increase in the breakdown of branched amino acids and muscle proteins, thus inhibiting muscle protein synthesis [21,22,23,24] and resulting in increased occurrences of sarcopenia in late stage patients with chronic kidney disease [25].