Objective  To investigate ultrasound-guided radiofrequency ablation (RFA) in the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients and its possible injury to recurrent laryngeal nerve.  Methods A total of 18 CKD patients with SHPT and admitted to the Blood Purification Center of Department of Nephrology, The First Affiliated Hospital of Henan University of Science and Technology from September 2020 to February 2022 were selected as the research subjects. Venous blood was collected before RFA and after RFA for one day, 7 days, one month, 3 months and 6 months to assay serum intact parathyroid hormone (iPTH), phosphorus, calcium and alkaline phosphatase (ALP). Their bone pain, skin pruritus, muscle strength grade and other complications were recorded.  Results  After RFA for one day, 7 days, one month, 3 months and 6 months, serum calcium, phosphorus, iPTH and ALP decreased as compared with those before RFA (calcium: F=38.637, P＜0.001; phosphate: F=44.175, P＜0.001; iPTH: F=369.836, P＜0.001; ALP: F=29.954, P＜0.001). Within 7 days after RFA, serum calcium decreased to the lowest (χ2=5.532, P=0.016, compared with those before RFA), and serum calcium increased and stabilized after supplement of calcium to the patients. After RFA, bone pain, blurred vision and pruritus relieved significantly, and muscle strength grade increased (vision: F=9.076, P＜0.001; pruritus: F=439.309, P＜0.001; muscle: F=3.755, P＜0.001). Six of the 18 patients (33.33%) had hypocalcemia of different degrees. Recurrent laryngeal nerve injury occurred in 5 patients (27.78%). Higher serum iPTH recurred but without symptoms and neck pain in 3 patients (16.67%).  Conclusion Ultrasound-guided RFA is effective for the treatment of SHPT in CKD patients. It can relieve bone pain, pruritus and improve muscle strength, with higher safety.