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[10] Initial assessment involves: Detailed medical history, including dietary habits and gastrointestinal symptoms Medication review (certain drugs like metformin and proton pump inhibitors can affect B12 absorption) [20] [21] Family history of pernicious anaemia or autoimmune conditions Physical examination for signs of anaemia or neurological abnormalities Laboratory investigations typically include: Serum vitamin B12 level: The primary test, though interpretation can be complex

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In CKD of other aetiologies than CRN, CS is also a suggested pathomechanism [60]

L-carnitine reduces severity of physical and mental fatigue and improves daily activities in the elderly