【Abstract】Objective To investigate the risk factors for postoperative severe hypocalcemia (SH) in maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). Method The clinical data of 59 MHD patients with SHPT and undergoing PTX in Shanghai General Hospital from May 2010 to May 2018 were collected. Based on postoperative serum calcium level, they were divided into group A (with SH) and group B (without SH). Multivariate logistic regression analysis was used to determine the risk factors for postoperative SH. Results Among the 59 patients, hypocalcemia occurred in 49 cases and SH in 32 cases. Multivariate regression analysis showed that preoperative alkaline phosphatase (β= 0.185, P=0.045), preoperative parathyroid hormone (β=0.004, P=0.040) and dry weight (β=0.027, P=0.034) were the risk factors for postoperative SH. Conclusion Preoperative alkaline phosphatase, preoperative parathyroid hormone and dry weight are the risk factors for SH in MHD patients with SHPT after PTX.