Secondary hyperparathyroidism in patients with renal failure can result in a number of symptoms, including Osteitis fibrosa cystica with arthritis, bone pain, and pathologic fractures Spontaneous tendon rupture Proximal muscle weakness Extraskeletal calcifications, including soft tissue and vascular calcification Pruritis Secondary hyperparathyroidism can develop in patients with moderate chronic kidney disease (estimated glomerular filtration rate < 60 mL / minute), but it is usually more advanced in patients who require long-term dialysis.