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doi: 10.1007/s00432-017-2464-9 37 YangWSSriramaratnamRWelschMEShimadaKSkoutaRViswanathanVSet al

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I think something that should also be noted for higher voltage and cell count is the increased amp draw

The prolonged exposure of renal cells to oxidative damage impairs the ability of the tubules to transport, absorb, and excrete electrolytes and water, and leads to fibrosis and loss of kidney function