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Protein-bound uremic toxins (IS, pCS, PAGln) accumulate exponentially as eGFR declines below 60 mL/min/1.73 m 2 due to saturable OAT1/3-mediated tubular secretion (113, 167), with patients at eGFR 30 exhibiting 510 higher IS than those at eGFR 90reflecting clearance impairment rather than unique pathogenic mechanisms

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However, strong clinical evidence is limited, and the overall bleeding risk is not well established

It also supports digestive function, potentially easing some of the gastrointestinal side effects that make tirzepatide hard to tolerate for certain patients

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