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IntroductionSecondary hyperparathyroidism remains the main complication of mineral and bone metabolism in patients with chronic kidney disease. In patients with resistance to medical treatment (native and active vitamin D, calcium and calcimimetics), parathyroidectomy surgery is indicated. The aim of this retrospective study is to show the change in incidence and the outcomes of parathyroidectomy in our center between 1980 and 2020, as patient characteristics and diagnostic and therapeutic strategies have changed.Patients and methodsWe collected data from patients on dialysis who had a first parathyroidectomy between 2000 and 2020 (period 2) in the same surgery department, and compared them with historic data between 1980 and 1999 (period 1) for patients who underwent surgery in another center.ResultsIn period 1, 53 parathyroidectomies were performed (2.78/year, 0 to 5, 8.5/1000 patient-years) vs. 56 parathyroidectomies in period 2 (2.8/year, 0 to 9, 8/1000 patient-years). The patients were comparable across the two periods, except for the longer duration of dialysis in period 1 (149±170 vs.89±94 months; p=0.02). In comparison with patients on dialysis not requiring parathyroidectomy during the same period, patients who underwent parathyroidectomy were younger, had been on dialysis for longer, and had a lower prevalence of diabetes, but more often had glomerulopathy or polycystic disease. Neck ultrasound, which was systematically performed in period 2, identified at least one visible gland in 78.6% of cases while scintigraphy, performed only in 66% of cases, identified at least one gland in 81% of cases. Twelve months after surgery, PTH > 300 pg/mL (a marker of secondary hyperparathyroidism recurrence or surgery failure) was present in 30% of patients in period 1 vs. 5.3% in period 2. Hypoparathyroidism was also more frequently observed in period 2 (35.7 vs. 18.8%). Surgical complications were also higher in period 1.ConclusionDespite therapeutic and strategic advances, there has been no change in the incidence of severe secondary hyperparathyroidism. Risk factors include excessively high PTH targets, suboptimal prevention before dialysis, and poor tolerance of calcimimetics. Parathyroidectomy surgery is safe and effective in the hands of a specialized team with ultrasound and scintigraphic preoperative assessment.