A more likely reason for deficiency would be low absorption in the gut, probably because of pernicious anemia or another condition
Anything that overloads the liver or drives oxidative stress will burn through your reserves before they reach the rest of the body
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Subsequent increases in the permeability of the intestinal barrier in CKD patients promote the translocation of bacterial products of intestinal origin, such as LPS, uremic toxins, and cytokines, into the systemic circulation, resulting in local and systemic inflammation, as well as oxidative stress associated with CKD (Krukowski et al., 2023
It binds IGF-1 receptors and switches on the bodys build-and-repair pathways, which is why its talked about for muscle growth, faster recovery, fat breakdown, improved nutrient partitioning, and even skin repair (HubMed Ed)
Zhao WQ, De Felice FG, Fernandez S, et al