Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disorder characterized by abnormal mineral metabolism(Ca, P, PTH, and vitamin D), bone turnover, and vascular calcification. Secondary hyperparathyroidism (SHPT) refers to the biochemical abnormalities that characterize CKD-MBD. Each condition is associated with increased risks for morbidity and mortality across the spectrum of CKD. In this presentation, I will discuss the pathogenesis of SHPT in CKD patients. Monitoring biochemical parameters for the management of CKD-MBD with the aspect of bone and vascular calcification will discuss. Lastly, I will discuss CKD-MBD treatment, including vitamin D and calcimimetics for SHPT.