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This is because issues with regular function of the gastrointestinal tract can prevent the proper release and absorption of the vitamin which causes deficiency
PubMed reference (NNMT inhibition & metabolic health)
8.6 Renal Impairment M.V.I
Lamouri I, Elouali A, Kamaoui I, et al
The methodological quality of the included studies, as assessed through the Jadad and NewcastleOttawa scales, varied from moderate to high, while the GRADE assessment indicated moderate certainty of evidence for serum vitamin B12 increase and low certainty for homocysteine reduction
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