Objectives: to find the efficacy and safety of cinacalcet for the treatment of SHPT in patients who had failed from vitamin D therapy in Songklanagarind hospital after new KDOQI guidelines and clinical practice  Methods: This was an retrospective cohort study in hemodialysis patients who had failed from vitamin D therapy and used cinacalcet at Songklanagarind hospital, from 1st October 2015 to 31st October 2017 and followed up for 6 months. Primary objective was response rate which was defined as serum iPTH level less than 585 pg/dL (< 9 fold upper normal limit for the assay) at 3 and 6 months of treatment and predictors. Secondary objectives was to find adverse events.  Results: 70 hemodialysis patients (mean age 60±13 years) were treated with cinacalcet. 48.6% of the patients were female. Baseline iPTH levels were 1,063 (842.5, 1,423.8) pg/dL. Patients responded at 3 and 6 months at 32.3% (21/65) (95%CI 0-43%, P=0.053) and 39.3% (24/61) (95%CI 0-50.7%, P=0.327) respectively. Predictors to response at 3 month were no hyperlipidemia(OR 3.46 (1.03,11.61)) and iPTH level before treatment < 900 pg/mL (OR 3.51 (1.13,10.91)). There was no predictor to response at 6 months. The most common adverse events were hypocalcemia (23%) and nausea (3%) without serious clinicals.  Conclusions: Cinacalcet is effective for the treatment of SHPT in the hemodialysis patient after failed to vitamin D even with delayed initiation and with new iPTH level goal of new KDIGO guideline without serious clinical complications.