الفهرس 
-Review of literature.Only 14 pages are availabe for public view
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Abstract
Since pure insulin level in ESRD represents the result of both secretion and elimation by dialyzers, reduced hepatic insulin clearance as in other subjects with insuklin resistance, and over seceretion of insulin, with decreased sensitivity to insulin in peripheral tissues, may contribute hyperinsilinemia (Liberman and Eldar ,2005)
Albumin isd wsynthesized exclusively in the liver. There independent processes have been implicated in suppressing the albumin synthetic rate in patients with chronic renal failure; metabolic acidosis, impaired protien intake and flammation . Mwetabolic acidosis has been reported to decrease albumin synthetic andv increase protien breakdown in chornic dialysis patients.