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Furthermore, TMAO enhances CaOx crystal deposition via oxidative stress and autophagy-related cell death, impairs renal function, and promotes kidney stones (Figure 9A)

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Accordingly, monitoring of total concentrations may be misleading since free concentrations may be substantially elevated in patients with hepatic disease whereas total concentrations may appear to be normal [seeBoxed Warning,Contraindications (4), andWarnings and Precautions (5.1)]

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