Since the retention of phosphate due to a decline in glomerular filtration rate (GFR) is the main pathophysiology of parathyroid gland hyperplasia and parathyroid hormone stimulation in patients with chronic kidney disease1,2, a higher level of preoperative serum phosphate level would reasonably be linked to a higher stimulation of PTH secretion and higher bone resorption and then higher skeletal mineral uptake after parathyroidectomy. The gene discussed is PTH; the disease is parathyroid hyperplasia.