Secondary hyperparathyroidism is one of the most important targets in the management of CKD-MBD. It has recently been confirmed in dialysis patients that lower PTH is associated with lower CV and fracture risk. Calcimimetic agents have revolutionized the control strategies for secondary hyperparathyroidism. Calcimimetics can suppress PTH without hypercalcemia and/or hyperphosphatemia in sharp contrast to VDRA. Furthermore, calcimicetics can suppress PTH and even regress nodular hyperplasia, which were never achieved by VDRA. Nevertheless, cinacalcet often causes GI symptoms, which leads to low adherence and difficulties in up-titration. These are reasons why we have developed a new calcimimetic agent, evocalcet. This new calcimimetic agent has been shown to effectively suppress PTH levels with significantly lower GI symptoms, not only in Japanese, but also in east Asian patients.