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It usually presents with pathological changes of glomerular filtration rate below 15 ml/(min1.73m^2), accompanied by retention of metabolites and toxins, and disturbance of water, electrolyte and acid-base balance as the main clinical features ( The elevated levels of TMAO in the blood of patients with ESRD have profound implications for their health status and comorbidities

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doi: 10.1179/2047773215Y.0000000030

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The impact of L-carnitine treatment on the TNF- level is difficult to determine [45]