Credit: Original article published here.By 2040, chronic kidney disease (CKD) is projected to be one of the top four leading causes of potential years of life lost. CKD is associated with various comorbidities and complications, including secondary hyperparathyroidism (SHPT) and vitamin D insufficiency (VDI). As patients experience decline in kidney function, there are significant alterations in the metabolism of calcium, phosphorus, and vitamin D that cause increased production and secretion of parathyroid hormone (PTH). The combination of decreased kidney function, mineral abnormalities, and high rates of comorbidities are associated with reduced quality of life for many patients. SHPT develops as a result of abnormalities in these parameters. Low levels of serum total 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D play a major role in the progression of SHPT. Concurrent diagnoses of CKD and SHPT have been linked to increased risk of progression of kidney disease, cardiovascular disease, and mortality. Patients with CKD and SHPT have significantly higher medical costs and use of health care resources compared with patients with CKD alone. Poor vitamin D status and elevated levels of PTH commonly occur in patients with stage 3 to 5 CKD, and can emerge as early as stage 2. Early and sustained