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4,16,17,18,19,20,21,22 Increased HIF activity in tubular epithelial cells prior to the onset of a toxic or ischemic renal insult appears to diminish the severity of tubular injury, which should be a beneficial effect, but increased expression of HIF in tubular epithelial cells has also been shown to trigger interstitial fibrosis, which is linked to loss of kidney function

The GIP component might partially activate without producing the synergistic effects seen at therapeutic doses

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