It has been about 18 months after the commercial release of sevelamer hydrochloride. I examined the phosphorus management in patient with hemodialysis with the use sevelamer hydrochloride. The phosphorus reduction of sevelamer hydrochloride was weaker than the precipitated calcium carbonate. Patients on artificial dialysis must undergo dietary therapy for the sevelamer hydrochloride to be effective. However, by switching from precipitated calcium carbonate to sevelamer hydrochloride, the calcium level dropped, and as a result the intact PTH rose. It was possible to subdue the rise of intact PTH with vitamin D. The usefulness of vitamin D dramatically increased with the decrease and the eventual cancellation of precipitated calcium carbonate. Furthermore, the calcium load lightened and the product of calcium and phosphorus decreased. At this point, I do not expect substantial phosphorus reduction from sevelamer hydrochloride. It must be recognized that the basis of phosphorus management is proper diet. Only with that can sevelamer hydrochloride be used to its fullest potential.