GH1 and nutritional deficiency disease: The pathophysiology of CKD-MBD is complex and multifactorial, multiple factors were identified such as abnormalities in calcium and phosphate metabolism, resistance to growth hormone (GH), modifications of the GH-insulin such as growth factor type 1 (IGF1) axis, hypogonadism, malnutrition, and drug toxicity (corticosteroids) [1].