Other possible mechanisms have been also documented, including altering circulating levels of uremic toxins 17, 20, tumor necrosis factor alpha (TNF-⍺), plasma nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX2) 18, SCFAs and bile acids 21 in association with changes of gut microbiota in patients receiving LPD. Here, TNF is linked to disseminated peritoneal leiomyomatosis.