PTH and vitamin D deficiency: As CKD progresses, its complications become increasingly prevalent and severe.(3) One such complication is the bone mineral disease (BMD), a systemic disorder involving biochemical alterations (in calcium, phosphorus, parathyroid hormone [PTH], and vitamin D), abnormalities in bone turnover, and extraskeletal calcification.(3,4) These biochemical disturbances can lead to secondary hyperparathyroidism (SHP), a condition with complex pathogenesis involving vitamin D deficiency, increased levels of fibroblast growth factor 23, hypocalcemia, and hyperphosphatemia.