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Renal impairment reduces B12 excretion, leading to accumulation

Patients who started with lower initial doses (like the 0.25 mg injection) and increased gradually reported fewer and milder fatigue episodes than those who moved through dose increases more rapidly

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Suhas Gondi , Srividya Chandramouli Iyer, Ramakrishna Meduri, Shruthi Sivakumar, Eric C