Secondary hyperparathyroidism (sHPT) is common in hemodialysis (HD) patients. The present study aimed to evaluate the efficacy and safety profile of etelcalcetide, a new peptide calcium-sensing receptor (CaSR) agonist in an observational study for the treatment of sHPT in CKD patients on HD.60 HD stable patients with sHPT were received etelcalcetide for 10 months. PTH levels, Ca, Ph, alb were measured before starting etelcalcetide and every month until the end of the protocol. Heart function was also evaluated. The primary outcome was estimation of PTH concentrations at the end of the treatment period. Secondary outcomes were monitoring of corrected serum Ca, ph. Adverse events were also evaluated.PTH significantly decreased from the first month of the treatment with etelcalcetide until the end of the study period.We also noticed significant reduction of the ph levels even from the second month of treatment. This trend also carried out for 8 months. Heart function remained stable. Ca levels remained in accepted area. None of the patients dropped out due to adverse events.Etelcalcetide is safe, well tolerated and effective in reducing PTH in HD patients with sHPT.