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In many hemodialysis patients at our hospital on May 2003, serum calcium levels were higher and intact PTH levels were lower than the target level of the K/DOQI guidelines. We could decrease doses of calcium-based phosphate binders by using sevelamer hydrochloride, and that could lower the level of calcium and raise the level of intact PTH. The number of patients who satisfy all the targets for calcium, phosphate, Ca x P and int-PTH, increased from 1.7% to 14.7% as a result of diet therapy and a change in their dose of medicine. It is natural that diet greatly influences on the control of calcium and phosphate, but if the period of hemodialysis is longer or there is swelling of the parathyroid, both diet therapy and medical therapy become more important for hemodialysis patients.