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Because cobalamin in normally absorbed from food through the gastrointestinal tract, chronic diseases that adversely affect the ability of the intestines to absorb nutrients (inflammatory bowel disease is an excellent example) can lead to cobalamin deficiency

Indoxyl sulfate, a uremic toxin, stimulates reactive oxygen species production and erythrocyte cell death supposedly by an organic anion transporter 2 (OAT2) and NADPH oxidase activity-dependent pathways

& Shadel, G

Cancer Research, 40 (7), 23302335

However, this perspective should be regarded as hypothesis-generating rather than evidence-based in pediatric populations, given the limited availability of long-term longitudinal studies assessing hard metabolic outcomes