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Although the renal clearance rate of this metabolite is typically high, renal insufficiency in chronic kidney disease (CKD) reduces TMAO clearance in CKD patients, elevating plasma levels of both TMAO and choline 10 and exacerbating poor renal function 8

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J Neurosci Res 79:240247 Bogaert YE, Sheu KF, Hof PR, Brown AM, Blass JP, Rosenthal RE, Fiskum G (2000) Neuronal subclass-selective loss of pyruvate dehydrogenase immunoreactivity following canine cardiac arrest and resuscitation