Spontaneous rupture of the Achilles tendons in hemodialysis patients is a rare complication. The majority of these patients have additional predisposing factors, such as previous use of fluoroquinolone antibiotics or corticosteroids. Spontaneous rupture of bilateral Achilles tendons without any of those predisposing factors is exceptional. In this paper, we report a 43-year-old woman who had been undergoing regular hemodialysis for 16 years. She developed bilateral spontaneous and simultaneous rupture of the Achilles tendons. She also developed pathological fracture of right femur neck 3 years later. Based on previous cases of tendon ruptures in uremic patients and the lack of history for the use of corticosteroids or fluoroquinolones, we believe that secondary hyperparathyroidism is the predisposing factor in this patient.