INS and chronic kidney disease: Although the Modification of Diet in Renal Disease (MDRD) study showed that CKD progression is minimally attenuated by a LPD27, the trial had several key limitations (i.e., patients with diabetes treated with insulin were not included, the effects of short-term vs. long-term effects of the outcome on eGFR slope were not accounted for, relatively short follow-up time to detect differences in dietary groups21,28).