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As kidney function declines, the bodys ability to remove uremic waste, heavy metals, phosphorus, and acid-forming compounds is compromised, leading to inflammation, metabolic acidosis, and methylation dysfunctionincluding elevated SAH, homocysteine, adenosine, and uric acid

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Accordingly, systematic dietary counseling and nutritional follow-up should ideally be implemented from pediatric age and reinforced during the transition to adulthood, to support healthy growth, optimize body composition, and mitigate long-term cardiometabolic risk [253]