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(2007), because the ketone body must be converted to acetyl-CoA, which is then processed by citrate synthase to produce citrate and CoA (acetyl-CoA + oxaloacetate, citrate + CoA), there is less oxaloacetate available for the transamination of glutamate to aspartate

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At the cellular level, CKD is remarkable by oxidative stress, abnormal autophagy, and mitochondrial dysfunction accompanied by significant alterations in cell signaling pathways such as HIF, TGF-, and p53 activation [21]