PTH and chronic kidney disease: The current evidence for cinacalcet in this systematic review is consistent with the UK National Health Service National Institute for Health and Clinical Excellence guidance recommending that cinacalcet should not be used for the routine treatment of elevated serum PTH levels in people with CKD and should be limited to people with elevated PTH concentrations refractory to standard therapy, with a normal or high serum calcium concentration, and in whom surgical parathyroidectomy is contraindicated because the risks of surgery outweigh the benefits [46].