ALB and malnutrition: Studies have indicated that individuals with CKD frequently suffer from anorexia, leading to a decrease in daily food intake, which can result in malnutrition and reduced plasma albumin levels, negatively impacting muscle protein synthesis and metabolism [34]. Therefore, METS-IR is deemed to be a more reliable predictor of CKD than HOMA-IR, since it consists of three direct components of metabolic syndrome (glucose, TG, and HDL-C levels) and one indirect component (BMI).