Objective: To evaluate the therapeutic effects of high dose pulse oral calcitro on moderate and severe secondary hyperparathyroidism patients. Methods: Two micrograms calcitrol twice a week were administered to 93 patients with secondary hyperparathyroidism whose intact PTH was more than 500 pg／ml, refractory to conventional calcitrol therapy（oral 0.25 micrograms calcitrol in each day for 8 weeks）. The clinical feature of observed patients, including sex, age, dialysis duration, serum calcium, phosphorus, iPTH and AKP level were analyzed. Results: Serum iPTH level decreased obviously in 74 patients in 8 weeks after high dose pulse treatment（P < 0.01）. Elevated calcium × phosphorus product occurred in 19 patients and the pulse treatment was stopped. Seventeen patients accepted total parathyroidectomy with forearm transplantation for hyperplastic parathyroids detected by ultrasound and ECT. Conclusion: High dose pulse oral calcitrol was effective on moderate and severe secondary hyperparathyroidism. The patients with obviously hyperplastic glands need the parathyroid operation.