PTH and chronic kidney disease: The clinical features of CKD-MBD are primarily due to the compromised renal excretion of minerals, leading to abnormality in circulating calcium, phosphorous, parathyroid hormone (PTH), and vitamin D. The secondary effects of this renal insufficiency include abnormalities in bone turnover, mineralization, volume, linear growth, strength, and ectopic calcification (vascular and soft tissues)3.