Objective : to evaluate the progression of vascular calcification in dialysis-dependent patients following parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) over long-term follow-up. Materials and methods . This prospective cohort study included 63 adult patients with stage 5 chronic kidney disease receiving renal replacement therapy. The main group (n = 55) underwent successful PTX for SHPT, while the control group (n = 8) received medical therapy. Cardiac computed tomography was performed to assess the coronary artery calcification (CAC) index, and lateral abdominal radiography was used for semi-quantitative assessment of abdominal aortic calcification (AAC). Assessments were conducted at baseline and after 18 months of follow-up. Results . The primary analysis included 44 patients in the PTX group and 6 in the control group who completed follow-up. The mean change in CAC was +452 (95% CI: –223 to 891; p = 0.101) in the PTX group and +1432 (95% CI: –772 to 2778; p = 0.065) in controls, with no significant between-group difference (Δ = –980; 95% CI: –2631 to 1542; p = 0.434). For AAC, the mean change was 0 points (95% CI: –1 to 1; p = 0.775) in the PTX group and +3 points (95% CI: –0.2 to 5.8; p = 0.038) in controls; the between-group difference approached significance (Δ = –2.9; 95% CI: –6.3 to 0.54; p = 0.098). Following PTX, serum calcium and phosphate levels decreased by 0.13 (0.29) mmol/L (p = 0.003) and 0.25 (0.64) mmol/L (p = 0.013), respectively, while remaining unchanged in the control group (effect sizes: 0.52 SD and 0.31 SD). Achieving target parathyroid hormone (PTH