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Chronic administration of high doses of oral levocarnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine, and trimethylamine-N-oxide, since these metabolites are normally excreted in the urine

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The bodys metabolic changes, triggered by uremia, can cause certain effects, like fatigue due to anemia

Glutathione works on the chemical environment