Spontaneous tendon ruptures in patients with end-stage renal disease (ESRD) have been reported rarely. We describe the largest own group of patients with spontaneous rupture of major tendons. Rupture of 16 tendons occurred in 9 patients. Mean patient age was 52.78 years; 77.7 % were male. Four patients were treated with hemodialysis, four received renal transplant and one was treated with automated peritoneal dialysis. Bilateral rupture was found in 5 patients (3 quadriceps, one Achilles and one supraspinatus and subscapularis tendon rupture). Distal brachial biceps tendon rupture, Achilles tendon rupture, unilateral quadriceps, and rupture of the oblique internal abdominal muscle tendon were developed by one patient each. Patients were treated with renal replacement therapy for 3 to 21 years (mean 12.89). Five patients were treated with steroids and 6 patients received quinolone antibiotic before the tendon rupture. All patients had laboratory and clinical signs of hyperparathyroidism. A patient who was treated with APD for 3 years had primary hyperparathyroidism with nephrolithiasis as the cause of ESRD. Our results demonstrated that patients with hyperparathyroidism are at increased risk for development of spontaneous tendon ruptures, and the risk is further amplified when they receive quinolone antibiotics and/or steroids.