Evidence has accumulated suggesting that the state of secondary hyperparathyroidism and the elevated blood levels of parathyroid hormone (PTH) in uremia participate in the genesis of many uremic manifestations. The present study examined the role of PIH in glucose intolerance of chronic renal failure (CRF). Intravenous glucose tolerance tests (IVGTI) and euglycemic and hyperglycemic clamp studies were performed in dogs with CRF with (NPX) and without parathyroid glands (NPX-PTX). There were no significant differences among the plasma concentrations of electrolytes, degree of CRF, and its duration. The serum levels of PTH were elevated in NPX and undetectable in NPX-PTX.The NPX dogs displayed glucose intolerance after CRF and blood glucose concentrations during IVGTT were significantly (P < 0.01) higher than corresponding values before CRF. In contrast, blood glucose levels after IVGTT in NPX-PTX before and after CRF were not different. K-g rate fell after CRF from 2.86±0.48 to 1.23±0.18%/min (P < 0.01) in NPX but remained unchanged in NPX-PTX (from 2.41±0.43 to 2.86±0.86%/min) dogs. Blood insulin levels after IVGTT in NPX-PTX were more than twice higher than in NPX animals (P < 0.01) and for any given level of blood glucose concentration, the insulin levels were higher in NPX-PTX than NPX dogs.Clamp studies showed that the total amount of glucose utilized was significantly lower (P < 0.025) in NPX (6.64±1.13 mg/kg *min) than in NPX-PTX (10.74±1.1 mg/kg *min) dogs.The early, late, and total insulin responses were significantly (P < 0.025) greater in the NPX-PTX than NPX animals. The values for the total response were 143±28 vs. 71±10 ;&U/ml, P < 0.01. There was no significant difference in the ratio of glucose metabolized to the total insulin response, a measure of tissue sensitivity to insulin, between the-two groups. The glucose metabolized to total insulin response ratio in NPX (5.12±0.76 mg/kg min per ttU/ml) and NPX-PTX (5.18±0.57 mg/kg. min per pU/ml) dogs was not different but significantly (P < 0.01) lower than in normal animals (9.98±1.26 mg/ kg.in per pU/ml). The metabolic clearance rate of insulin was significantly (P < 0.02) reduced in both NPX (12.1±0.7 ml/kg min) and NPX-PTX (12.1±0.9 ml/kg min) dogs, as compared with normal animals (17.4±1.8 ml/kg min). The basal hepatic glucose production was similar in both groups of animals and not different from normal dogs; both the time Address correspondence to Dr. Massry, Division of Nephrology.