A cinacalcet-treated dialysis patient with severe SHPT and increased alkaline phosphatase levels developed hypocalcemia, pronounced hypophosphatemia, and severe diffuse bone pain during treatment.[18,38] An advanced investigation of the relationship between changes in plasma PTH levels and serum phosphorus levels during treatment with cinacalcet found that reduced PTH levels after 13–26 weeks of cinacalcet treatment were associated with corresponding reductions in serum phosphorus. This evidence concerns the gene PTH and hypophosphatemia.