The imbalance between muscle catabolic and anabolic pathways have been well documented in CKD; these pathways include the overactivation of the ubiquitin proteasome system, dysregulation of autophagy, increased caspase and calpains, and impaired insulin growth like factor 1 (IGF-1) signaling, which manifests as severe muscle wasting (6–15). The gene discussed is IGF1; the disease is chronic kidney disease.