PTH and Hypocalcemia: Secondary hyperparathyroidism (SHPT) is a common and serious complication of end-stage renal disease.[1] It is characterized by elevated levels of parathyroid hormone (PTH) because of hypocalcemia, hyperphosphatemia, and vitamin D deficiency in end-stage renal disease.[2] SHPT can cause vascular calcification, soft tissue calcification, bone pain and fracture.[3,4] High PTH levels are associated with an increased risk of mortality.[5,6] In the early stage, SHPT can be controlled with drug therapy.