Objective: To assess the efficacy and safety of total parathyroidectomy (PTX) with forearm autograft for secondary hyperparathyroidism (SHPT) due to chronic renal failure. Methods: The clinical data of 30 patients with end-stage chronic renal failure and SHPT undergoing PTX with forearm autograft from December 2011 to December 2015 were retrospectively analyzed. Of the patients, the improvements of clinical symptoms and changes in serum level of intact parathyroid hormone (iPTH), calcium, phosphorus and calcium-phosphorus product after surgery as well as the postoperative complications and recurrence were analyzed. Results: Operation was performed successfully in all patients. After operation, the clinical symptoms of these patients were all remarkably improved, their serum levels of iPTH, calcium, phosphorus and calcium-phosphorus product were all significantly decreased compared with preoperative values (all P<0.05). Transient recurrent laryngeal nerve injuries occurred in 12 patients, and all recovered without treatment. Postoperative recurrence occurred in 8 patients (2.7%) and 7 of them underwent repeat operation, after which the symptoms were improved. Conclusion: PTX with forearm autograft is a safe and effective treatment for SHPT caused by chronic renal failure.