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As a new uremic toxin and potential biomarker, TMAO is involved in changes in the heart-gut-kidney axis, including neuroendocrine activation, hemodynamic changes, alterations in gut microbiota, and intestinal congestion (Xiong et al., 2023)

Additionally, they preserve mitochondrial integrity and suppress ROS-induced AMPK-FoxO3 and glucocorticoid pathways, while enhancing antioxidant responses and HSP70 expression

Evaluation of bias risk The Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2) was utilized to critically assess the papers that were part of our investigation ( Supplementary Appendix S2, S3

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