It is also possible that, despite the KDOQI guidelines opinion-based recommendation for PTX in patients “with severe hyperparathyroidism (persistent serum levels of intact PTH >88.0 pmol/L [800 pg/mL]), associated with hypercalcemia and/or hyperphosphatemia that are refractory to medical therapy”[19], Canadian physicians may be more inclined to wait for symptomatic hyperparathyroidism before sending a patient for a PTX. The gene discussed is PTH; the disease is hyperphosphatemia.