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Your bones may deteriorate if your damaged kidneys are unable to metabolize vitamin D, which aids in calcium absorption

Cytosolic acetoacetate is converted to acetoacetyl-CoA which is then hydrolyzed into two moles of acetyl-CoA as described in the Nonoxidative Metabolic Fates of Ketones section below

This direct route makes it incredibly effective, especially for anyone who struggles with absorbing B12 through their gut, such as those with pernicious anemia