Secondary hyperparathyroidism is one of the most common complications in patients with chronic kidney disease. These patients frequently complicated with disorders of mineral and bone metabolism and cardiovascular disease. The pathophysiology of secondary hyperparathyroid disorder is complex and involves hypocalcemia, hyperphosphatemia and decreased calcitriol activity. The treatment of patients with hyperparathyroidism varies depending upon correction of hypocalcemia and hyperphosphatemia by restricting dietary phosphate intake, administering phosphate binders and vitamin D supplement in calcitriol deficiency. Calcimimetics is the alternative treatment in patients complicated with hypercalcemia. Parathyroidectomy is indicated when medical treatment fails. Efficacy of ultrasound-guided percutaneous ethanol or vitamin D injection therapy remained to be determined.