The complex relationship involving PTH, phosphorus metabolism, and vitamin D in CKD is incompletely understood, particularly the signaling pathways and molecular entities that dictate PTH secretion in response to shifts in phosphorus handling and vitamin D status through different stages of CKD (Kritmetapak & Pongchaiyakul, 2019; Yang et al., 2011). This evidence concerns the gene PTH and chronic kidney disease.