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Dialysis-associated carnitine deficit, in turn, has been linked to a number of symptoms seen in uremic patients, including fatigability, cardiomyopathy, anemia, and skeletal muscle weakness (Eknoyan et al., 2003)

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However, pregnancy and certain health conditions may cause increased excretion of carnitine, which could increase risk of deficiency

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Meanwhile, fumaric acid is a key constituent of the Krebs cycle, fueling this process even more