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In contrast, a high-protein diet enhanced renal IGF-1 levels only in normal rats, suggesting that the additional effects of a high-protein intake on compensatory renal hypertrophy are partially mediated by GH signaling.77 In fact, the renal anabolic effects of the high-protein diet are attenuated by the inhibition of the GH receptor.78 Particularly, protein and energy wasting (PEW) is commonly observed in hemodialysis patients and likely associated with a lower protein and caloric intake.79 In this respect, circulating IGF-1 has been well-established as a marker for nutritional deficiency in hemodialysis patients for decades.80,81 Thus, patients undergoing hemodialysis with decreased muscle mass and a history of infections often show decreased serum IGF-1 levels, showing high sensitivity (77%) and moderate specificity (52%) as a marker of nutritional status.82 Compared to controls on a low-protein diet, rats fed a high-protein diet showed increased IGF-1 levels in the serum, liver and glomerulus, but not in the renal cortex, which resulted in higher total body and kidney weight but not liver