Secondary hyperparathyroidism is inevitable in the chronic renal failure state. The pathogenesis of it is multifactorial, such as hypocalcemia, low level of 1,25(OH)(2)D(3), bone resistance to PTH calcemic action, decreased vitamin D receptor, decreased Ca-sensing receptor, as well as hyperphosphatemia. Recent enthusiastic studies revealed the direct and strong effect of phosphate (P) on PTH secretion. Then, the important role of plasma P suppression in the chronic renal failure patients has been recognized again. A new P binder polycation-polymer "sevelamer" has no calcium (Ca) and no aluminum (Al). It can lower the plasma P level without increase of Ca and Al, and can decrease plasma PTH level simultaneously.