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La somministrazione cronica orale di alte dosi di levocarnitina in pazienti con grave compromissione della funzione renale o con insufficienza renale allo stadio terminale (ESRD) e dializzati pu indurre un accumulo dei metaboliti potenzialmente tossici trimetilamina ( TMA) e trimetilamina-N-ossido (TMAO), in quanto questi metaboliti vengono normalmente escreti con le urine