Only rarely is a medication introduced with the potential to fundamentally alter care for patients receiving maintenance dialysis. In the history of nephrology, or at least of dialysis, the most impactful of these was surely epoetin alfa. Not until cinacalcet, the first-in-class allosteric modulator of the calcium sensing receptor (CaSR) introduced in 2004, did a medication of even remotely similar potential importance appear.1 Although secondary hyperparathyroidism (SHPT) does not constitute as grave a threat as severe anemia, allosteric modulators of the CaSR offered an exciting new mechanistic pathway with which to treat SHPT, complementing use of vitamin D sterols.