Parathyroid hormone (PTH) and vitamin D play important roles in maintaining calcium balance. PTH contributes to the increase of serum calcium levels by promoting the release of calcium from bones, increasing calcium reabsorption in the kidneys, and stimulating the activity of 1-alphahydroxylase, which converts inactive vitamin D (25-hydroxy vitamin D) into its active form, calcitriol (1,25-dihydroxy vitamin D). Reduced synthesis of the enzyme 1-alpha-hydroxylase is noted in Chronic Kidney Disease, decreasing the presence of calcium in serum, and by entering in a hyper parathyroid state, the body tries to compensate for the hypocalcemia.
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Alick et al. (2024) studied this question.
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