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10.18632/oncotarget.14884 37 de CaboR.MattsonM

Although the exact cause of subnormal serum aminotransferase levels in CKD remains controversial, possible reasons are the severity of the impairment of renal function caused by glomerular dysfunction, pyridoxine deficiency and/or the presence of an inhibitory substance in uremia

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Similar changes were observed in tissue GCL activity which is the rate limiting step in GSH synthesis

This means B12 deficiency is real and underdiagnosed, but it is not universal and not everyone experiencing fatigue has a B12 problem