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Furthermore, peripheral insulin resistance triggered by uremia, metabolic acidosis and low-grade inflammation is common in CKD (80), leading to intra-portal hyperinsulinemia, but does not necessarily increase hepatic sensitivity to GH because of the reduced hepatic expression of IGF-I and GHR mRNA (81)
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Selenium deficiency is also characterized by elevated levels of oxidative stress markers in the liver 21 , which significantly contribute to liver injury 17
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