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Similarly, associations among serum IGF-1 concentration and serum levels of phosphate, calcium, FGF23 and bone mineral density have been shown in patients with advanced CKD, which also supports the link between mineral metabolism and IGF-1 regulation in CKD patients.73 In patients with acromegaly, higher renal IGF-1 is associated expression with increased serum and urinary calcium levels, elevated serum phosphate and calcitriol concentrations, along with decreased serum PTH levels