IGF1 and chronic kidney disease: Through the insulin-like growth factor-1 (IGF-1)/phosphatidyl inositol-3 kinase (PI3K)/protein kinase B (Akt) pathway [20], one of the most explored anabolic signaling pathways affecting muscle in CKD, proteolysis in muscle cells occurs when there is a suppression of PI3-K activity in muscle that is induced, for example, by acidosis, leading to accelerated muscle proteolysis [20].