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Consequently, an attempt was made to emulate that effect in patients with cirrhosis and HE in a pilot study, and GPB was shown to be capable of reducing NH3 levels in those patients.50 A later study by Rockey et al

The hyperglycemia-related increased proximal tubular sodium reabsorption results in lower sodium levels at the level of the macula densa increasing GFR via inhibiting TGF, further augmenting the amount of filtered and reabsorbed sodium with increased ATP demands