PTH and secondary hyperparathyroidism: In more advanced stages of CKD, pharmacological strategies to lower FGF23 levels include non-calcium phosphate binders such as sevelamer and nicotinamide (vitamin B3), calcimimetics such as cinacalcet, and non-pharmacological strategies such as parathyroidectomy in patients with severe secondary hyperparathyroidism (PTH levels greater than 1000 pg/mL without remission after pharmacological treatment) and dialysis in its various forms [57].