Patients with CKD or end-stage kidney disease (ESKD) suffer disturbances in calcium and phosphate metabolism, decreased calcitriol synthesis, increased synthesis and secretion of PTH and metabolic acidosis, which results in the presentation of histopathologic changes observed in bone, typically characterized by changes in bone turnover (can range from low to high), volume (can range from low to high), and mineralization (can be normal or abnormal) [7,12]. The gene discussed is PTH; the disease is metabolic acidosis.