The 2013 NICE guideline on hyperphosphataemia management suggests using a calcium-based binder as first line treatment in the management of hyperphosphataemia in adults with CKD 4–5 and on dialysis, and either combining with, or switching to, a non-calcium-based binder if hypercalcaemia develops, if serum parathyroid hormone levels are low or if hyperphosphataemia persists despite adherence to the maximum recommended or tolerated dose of calcium-based phosphate binder [14]. The gene discussed is PTH; the disease is hyperphosphatemia.