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. This evidence concerns the gene PTH and chronic kidney disease.