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The metabolic effects are complementary but distinct

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However, it can also produce harmful metabolites such as ammonia from urea and uremic toxins such as trimethylamine N-oxide (TMAO), p-cresyl sulfate (PCS), and indoxyl sulfate (IS), which cause systemic inflammation and other significant effects, such as alterations in the metabolism of drugs due to the inhibition of some isoenzymes, highlighting CYP3A4, which are extremely important in the metabolism of approximately 40% of drugs and would partly explain the variability between individuals with kidney failure [38]