The most common form of renal bone disease is secondary hyperparathyroidism, how should it be treated in advanced stages? Surgical treatment such as parathyroidectomy or minimally invasive parathyroid ultrasound radiofrequency treatment may be required, but radiofrequency treatment is often less effective than surgery (equivalent to partial parathyroidectomy) and is only indicated for a subset of patients who have some of the gland remaining after surgery, are too old for surgery, and other reasons. How is parathyroidectomy performed? Parathyroidectomy is often unavoidable for patients on long-term dialysis, mainly, of course, for younger patients. For example, for patients who start dialysis under the age of 50, they may have a survival period of ten, twenty or even thirty years, a condition that usually requires this type of surgery. But for patients who start dialysis in their 70s or 80s, they may only have a survival period of five to ten years, in which case surgery is usually not needed. Is surgery effective? The therapeutic effect of surgery depends on the grasp of the indications, the experience of the surgeon and the multidisciplinary cooperation of medical-surgical anesthesiology, etc. Usually, bone pain and itching will improve quickly after surgery, followed by improvement in nutrition, sleep, muscle strength, and cardiovascular system, which will give the patient a feeling of rebirth and can significantly improve the patient’s quality of life. In addition, after the release of Sinacase, a drug that can nearly replace the efficacy of surgery, many patients on long-term dialysis in developed countries will no longer have to undergo parathyroidectomy. However, this drug is currently self-funded and relatively expensive in our country. Which patients are suitable for parathyroidectomy? Most patients can have such an open neck surgery as long as they are within 75 years of age, have relatively good cardiopulmonary, coagulation, and liver function, and can tolerate anesthesia (general anesthesia mainly). What are the effects on the patient’s own body after removal of the parathyroid glands? In fact, these patients who need surgery have a very severe case of hyperparathyroidism. Patients with abnormally elevated parathyroid hormone can cause severe bone damage and can suffer from bone pain, joint pain, and itchy skin. However, these symptoms are quickly relieved after surgery because the enlarged and redundant parathyroid glands are removed. Our main research question now is whether low parathyroid hormone after surgery is harmful to the patient or not. It is currently considered ideal to maintain parathyroid hormone at around 100ng/L after surgery, but in practice this is difficult to achieve. Usually, some patients have low parathyroid hormone after surgery, with some patients having only 20ng/L, 10ng/L or even 0. In this case, we are concerned about the risk of such low parathyroid hormone in the long term. There are a few reports in the literature that after long term observation of low parathyroid hormone there is no significant risk of diseases such as low transit bone disease and vascular calcification. However, some individual experts believe that there is still a relatively high risk of prolonged low parathyroid hormone, such as the possibility of increased risk of cardiovascular calcification. We are currently conducting a long-term follow-up study with the support of the Beijing Municipal Commission of Science to observe whether there is a risk of too low parathyroid hormone after surgery and whether it may aggravate cardiovascular calcification.