Currently, the accepted indications for PTX in secondary HPT are: persistent (more than 6 months) elevation of PTH >800 pg/mL despite pharmacological treatment with the maximum tolerated dose of vitamin D analogues and calcimimetics, or when PTH is between 600 and 800 pg/mL associated with persistent hypercalcemia or hyperphosphatemia (corrected calcium greater than 10.2 mg/dL, or phosphorus greater than 5.5 mg/dL) despite diet and treatment, high risk of calciphylaxis, and erythropoietin refractory anemia [26]. This evidence concerns the gene EPO and anemia.