This multifactorial condition is driven by chronicinflammation, RAAS activation, uremic toxins, metabolic acidosis, gut microbiotadysregulation, and oxidative stress - hallmarks of CKD - which collectivelydownregulate the GLUT4 glucose transporter responsible for insulin-dependentcellular glucose uptake (19,20).Diabetes is reported in approximately 28% of CKD patients and remains the leadingglobal cause of ESKD (19,20). Here, INS is linked to chronic kidney disease.