Subtotal or total parathyroidectomy was performed on 11 patients with secondary hyperparathyroidism associated with advanced renal disease. All patients had failed to respond to prior medical treatment. Indications for operation included one or more of the following clinical manifestations: (1) radiographic evidence of osteodystrophy, (2) soft tissue calcifications, (3) intractable pruritus, and (4) persistent hypercalcemia. One postoperative death occurred due to cardiovascular complications. Despite severe metabolic derangements, the operation was well tolerated by the other ten patients. Removal of three to four parathyroid glands resulted in significant clinical improvement in seven patients. The procedure was of questionable value in three patients.