**7. Summary**

Whereas there are insufficient high-quality randomized controlled trials in the field, this shortcoming should not lead to a nihilistic approach to the relevant clinical problems of hemodialysis patients with sHPT. Nevertheless, because of insufficient clinical data, a single treatment modality, be it phosphorus binders, vitamin D substitution with inactive forms or vitamin D receptor activators, calcimimetics or parathyroidectomy may not claim to be uniformly superior to the others, and a wider therapeutic window often prompts the use of a combination of these options and individualization of sHPT management. The ultimate goal is to improve the very poor survival of hemodialysis patients, so any suggested approach for the management of sHPT should be tested.
