Background Our aim was to determine whether chronic renal insufficiency (CRI) impacts intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy. We hypothesized that ioPTH monitoring in patients with chronic CRI would show slower decline, but still accurately predict cure. Methods A retrospective review of patients with primary hyperparathyroidism who underwent curative single adenoma parathyroidectomy. The percentage of patients reaching 50% decline of ioPTH was compared between groups stratified by renal function. Results Between 2000 and 2013, 950 patients met inclusion criteria. At five minutes, 66% of patients with CRI met curative criteria vs. 77% of normal renal function patients (p=0.001). At ten minutes, 89% vs. 92% met criteria (p=0.073), and by fifteen minutes, the gap narrowed to 95% vs. 97% (p=0.142). Conclusions Despite CRI patients with primary hyperparathyroidism having slower ioPTH decline after curative parathyroidectomy, 95% met ioPTH criteria by 15 minutes. Standard ioPTH criteria can be used with CRI patients.