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The decline in glomerular filtration rate also activates compensatory mechanisms, including the RAAS, the sympathetic nervous system, and the calcium-parathyroid axis, all of which have adverse effects on the cardiovascular system [53]

This stepped approach is sometimes called a 'titration' schedule, and it allows your healthcare provider to find your optimal therapeutic dose rather than jumping straight to a high amount

Acknowledgements The authors acknowledge the following grant support: A.C

In fact its a time bomb and there will be guaranteed casualties amongst B12 deficient patients who only take oral tablets during this period