Secondary hyperparathyroidism (SHPT) is one of the factors reported to have a negative impact on anaemia of chronic kidney disease (ACKD) and its treatment. SHPT is one of the abnormalities resulting from altered bone mineral metabolism. Five possible mechanisms have been proposed as to how SHPT impacts on anaemia in this paper. Each of these mechanisms will be considered and the treatment options reviewed including the implications for erythropoietic stimulating agents (ESA) prescribing. Anaemia and SHPT are both strongly predictive of complications and death from cardiovascular events in patients with chronic kidney disease (CKD). Nursing care of this group of patients should, therefore, be holistic in order to ensure optimum management. Ways in which we can practice to enhance quality of life and outcomes in this patient population will be discussed.