The 2009 KDIGO guidelines suggested that in patients with CKD G3a–G5 and persistently elevated PTH, treatment with calcitriol or vitamin D analogues could be considered, whereas the 2017 KDIGO update took a more restrictive stance, recommending that active vitamin D analogues not be used routinely, but rather reserved for CKD G4–G5 patients with severe and progressive SHPT. This evidence concerns the gene PTH and chronic kidney disease.