What is the primary reason for hypocalcemia developing during end-stage renal failure or uremia?

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In end-stage renal failure or uremia, there is a deficit of activated vitamin D due to the kidneys' inability to convert vitamin D to its active form. This leads to decreased calcium absorption from the intestine and increased phosphorus levels, which further decreases calcium levels. Additionally, the kidneys' inability to excrete phosphorus leads to further mineral imbalances, exacerbating hypocalcemia.

What Is the Primary Reason for Hypocalcemia Developing During End-Stage