Left ventricular hypertrophy (LVH) is frequent in maintenance dialysis patients.[1] Several independent factors contribute to the development of LVH in dialysis patients including fluid overload, anemia, hypertension, hyperparathyroidism and arteriovenous fistula.[1–3] Recently, parathyroid hormone (PTH) has been identified as an important cardio-toxin in end stage renal disease (ESRD). The gene discussed is PTH; the disease is anemia.