Management of chronic kidney disease (CKD) is often fraught with derangements in calcium and phosphorus metabolism. The development of secondary hyperparathyroidism of renal origin begins in the early stage of CKD and usually progresses as the level of renal impairment advances. Treatment of SHPT is challenging, and maintenance of calcium and phosphorus level is an important determinant of cardiovascular and bone health. In this chapter, we focus on the pathogenesis, etiology, and treatment of secondary hyperparathyroidism secondary to chronic kidney disease.