For a study, researchers sought to create recommendations for the safe, suitable, and effective therapy of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism based on evidence. Patients who had end-stage kidney disease, chronic kidney disease, or kidney transplantation frequently developed hyperparathyroidism. Due to its complexity, a multidisciplinary approach was necessary for the surgical care of SHPT and THPT. The surgical management of SHPT and THPT was not covered by any clinical practice guidelines at this time. A group of 10 SHPT and THPT professionals looked into the medical literature from January 1, 1985, to the present day, January 1, 2021. The strongest evidence currently available was used to create recommendations. Levels of evidence were determined using the American College of Physicians grading system. There was discussion and agreement on recommendations. The American Association of Endocrine Surgeons members read and offered feedback on the draughts of the article. These clinical guidelines outline the epidemiology and pathophysiology of SHPT and THPT and offer advice for all concerned professionals about the diagnosis and treatment of SHPT and THPT. The preoperative, perioperative, and postoperative care of SHPT and THPT were covered in detail, along with relevant definitions, operative methods, morbidity, and outcomes. The following specific subjects will be covered: Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Evidence-based guidelines have been developed to help clinicians manage secondary and tertiary renal hyperparathyroidism as effectively as possible.