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This subjective improvement could reflect placebo effect, improved overall nutritional status from paying more attention to diet, natural adaptation to the medication over time, or actual b12 repletion if deficiency existed

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Although chronic kidney disease is not diagnosed until the eGFR reaches 60 mL/min, being able to detect earlier, less-significant decrements in kidney function is important, as the period of subclinical kidney dysfunction before overt kidney disease can be diagnosed based on creatinine may last one to two decades (Rush-Monroe 2013

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