【Abstract】Objective To investigate serum fibroblast growth factor-23 (FGF-23) level for the prediction of treatment efficacy of secondary hyperparathyroidism (SHPT) and to observe serum FGF-23 level for the treatment efficacy prediction of palicalcitol and calcitriol in maintenance hemodialysis (MHD) patients. Methods A total of 177 MHD patients with SHPT recruited from 7 hemodialysis centers of People's Hospital of Xinjiang Uygur Autonomous Region were included in this prospective, multicenter and cohort study. We used high FGF-23 level as the exposure factor, PTH level lower than 40% of the baseline value as the main endpoint event, and the presence of hypercalcemia and hyperphosphatemia as the secondary endpoints events. The endpoint events in patients were observed with the median follow-up period of 7.8 months. Results The prevalence of main endpoint event was lower in the patients with higher FGF-23 level than in those with lower FGF-23 level (25.84% vs. 71.59%, HR=0.74, 95% CI 0.31～0.98, P<0.001). The prevalence of hypercalcemia and hyperphosphatemia were higher in the patients with higher FGF-23 level than in those with lower FGF- 23 level (26.97% vs. 9.09%, HR=0.74, 95% CI 2.65～3.77, P=0.005 for hypercalcemia; 61.80% vs. 38.64%, HR=2.64; 95% CI 2.19～2.86, P=0.025 for hyperphosphatemia). In the patients treated with palicalcitol, the prevalence of main endpoint event was lower in patients with lower FGF-23 level than in those with

higher FGF-23 level HR=1.89, 95% CI 1.32-1.98, P＜0.001), and the same was found in patients treated with calcitriol (HR=1.15, 95% CI 1.03-1.29, P=0.039). Conclusion Patients with lower FGF-23 level had better curative effect with the lower prevalence of hypercalcemia and hyperphosphatemia. However, FGF-23 level had no influences on hypercalcemia and hyperphosphatemia in patients treated with calcitriol.