In high- to moderate-quality evidence from 16 randomized controlled trials involving 6,988 patients, routine cinacalcet (30 to 180 mg/d) therapy in people with CKD stage 5D decreases PTH concentrations (281 ng/l [32 pmol/l]), reduces hypercalcemia, and infrequently prevents surgical parathyroidectomy, but has little or no effect on all-cause mortality, has imprecise effects on cardiovascular death, and is associated commonly with adverse effects including hypocalcemia, nausea, vomiting, and diarrhea. The gene discussed is PTH; the disease is hypercalcemia disease.