B Background: Chronic renal disease – mineral bone disease (CKD-MBD) is characterized by irregularities in the metabolism of calcium, phosphorus, parathormone hormone (PTH), or vitamin D, and abnormalities in mineralization, bone turnover, and the calcification of soft tissues or blood vessels. Serum parathormone or bone-specific alkaline phosphatase measurements are used to evaluate bone disease, as elevated or diminished values indicate underlying bone turnover. Methods: The study included ninety patients with end stage renal disease (ESRD) undergoing regular hemodialysis at the hemodialysis unit at El-Minia University Hospital from 2022 to December 2023May, the aim is to study MBD in those patients and the diagnostic value of plasma b-ALP as a marker of bone turnover. After obtaining informed consent, laboratory tests conducted, including a complete blood count, blood sugar, lipid profile, CRP, blood urea, serum creatinine, albumin, total calcium, phosphate, bone specific alkaline phosphatase, and PTH level evaluation. Results: High PTH level was prevalent in 23.3% of the studied patients and low parathyroid level in 10% and Serum calcium and bone-specific alkaline phosphate levels show high significant correlation with PTH level. Symptoms of MBD were common in both low and high bone turnover populations. In the study, 57% of the individuals had hypocalcemia. In 66.7% of the patients, PTH was within the normal range. Conclusion: The percentage of MBD among the HD patients under study was 33.3%, majority of patients with low PTH levels had high serum Ca and low bone specific alkaline phosphatase.