With the continuous increase of dialysis patients and the prolongation of dialysis time, the prevalence of chronic kidney disease (CKD) related secondary hyperparathyroidism (SHPT) is rising, and so is the number of patients requiring surgical intervention. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism was developed in 2022. Based on evidence-based medicine, the guidelines standardized the surgical indications for SHPT and tertiary hyperparathyroidism (THPT), with a systematic comparison of the strengths and weaknesses of different surgical approaches, and fully introduced the reoperation for patients with postoperative recurrence. However, due to the lack of RCT data, the evidence levels of some recommendations of the guidelines are relatively low. Here, the authors emphatically interpret the relevant surgery parts of the guidelines for SHPT due to renal failure, aiming to assist surgeons in further deepening their knowledge in the management of SHPT and promoting the standardization of its diagnosis and treatment.