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This overactivation contributes to increased cyst number and area.72 Despite the controversy surrounding the various actions of the IGF-1, lower serum IGF-1 levels have been associated with shorter survival rates in patients undergoing one year on dialysis,73 whereas hemodialysis patients with low serum IGF-1 levels had a higher mortality rate, an association that remained significant after adjusting for demographic factors, inflammatory markers, co-morbidities, and biomarker of renal function.74 These studies suggest that, systemic IGF-1 may play a role in preventing mortality in ESRD patients, and could serve as an useful circulating marker of survival in this population
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