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These effects of the IGF-1 persisted even in thyroparathyroidectomized rats, suggesting a PTH-independent mechanism.93 In addition, 1-alpha hydroxylase activity is synergically increased by IGF-1 administration in rats fed a phosphorus deficient diet, which suggests also distinct mechanisms.94In vitro experiments with renal proximal tubular cells have demonstrated the direct stimulatory effects of IGF-1 and P depletion on calcitriol synthesis.95 In patients undergoing hemodialysis, recombinant GH administration results in a subsequent increase in plasma IGF-1 concentration, accompanied by reductions of the blood urea nitrogen (BUN), urea generation, protein catabolic rate, phosphate, and intact parathyroid hormone plasma (iPTH) concentrations,96 likely reflecting improved renal function

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