BACKGROUND: Secondary hyperparathyroidism (HPT) constitute a high-turnover bone disease, manifested by elevated parathyroid hormone. Cinacalcet, belonging to calcimimetics, has been shown to be promising in the control of secondary HPT with limited data in children.OBJECTIVE: To evaluate the safety and efficacy of cinacalcet in children on peritoneal dialysis (PD) with secondary HPT.METHODS: Four patients on PD with severe secondary HPT, uncontrolled with phosphorus dietary restrictions combined with phosphate binders and analog of 1,25 vitamin D3 received cinacalcet.RESULTS: After cinacalcet treatment, in two of four patients, we found a serum intact parathyroid hormone (iPTH) level reduction by more than 70% at 4 weeks and more than 60% at 3 or more than 6 months. Nevertheless, in the other two patients, a transient reduction of iPTH was found in 4 weeks and an increase in 3 or more months, who were finally treated with surgical parathyroidectomy. During cinacalcet treatment, no adverse events were noted.CONCLUSION: Cinacalcet may be a safe and effective treatment for PD patients with secondary HPT, although surgical parathyroidectomy cannot be avoided in certain cases.