PTH and chronic kidney disease: Thus, even a seemingly high level, like in our index case, may not represent elevated bone reformation when PTH secretion is stimulated by hypocalcemia and the normal reference range is modified by the presence of CKD. Moreover, in CKD, the calcium-PTH set point is altered, and after PTX, the adaptive response is eliminated, resulting in a tendency to long-term hypocalcemia and adynamic bone disease [9].