From the large amount of prospective data on surgical patients, the identifiable risk factors for AKI are age ≥56 years, male sex, active congestive heart failure, ascites, hypertension, preoperative creatinine >106 mol/L, diabetes mellitus (controlled by oral medications or insulin injections) (19–24), and patients with six or more risk factors have an increased incidence and hazard ratio of AKI (25). Here, INS is linked to diabetes mellitus.