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Furthermore, new caution became recommended with regard to the routine use of active vitamin D analogues in early CKD stages and moderate SHPT phenotypes, due to their potential risks for hypercalcaemia and hyperphosphataemia aggravation. Nevertheless, there is still a substantial clinical need to prevent the development of parathyroid gland autonomy, with its associated consequences of bone and vascular damage, including fracture risks and cardiovascular events. Therefore we now attempt to review the current guideline-based and clinical practice management of SHPT in ND-CKD, including their strengths and weaknesses, favouring individualised approaches respecting calcium and phosphate homeostasis. We further comment on extended-release calcifediol (ERC) as a new differential therapeutic option now also available in Europe and on a potentially novel understanding of a required vitamin D saturation in more advanced CKD stages. There is no doubt, however, that knowledge gaps will remain unless powerful randomised controlled trials with hard and meaningful endpoints are performed.<\/jats:p>","DOI":"10.1093\/ndt\/gfac236","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T16:38:21Z","timestamp":1660754301000},"page":"1397-1404","source":"Crossref","is-referenced-by-count":24,"title":["Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s"],"prefix":"10.1093","volume":"38","author":[{"given":"Markus","family":"Ketteler","sequence":"first","affiliation":[{"name":"Department , Stuttgart ,","place":["Germany"]},{"name":"of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus , Stuttgart ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol , Badalona, Catalonia 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