Kidney plays an important role in regulation of bone and mineral homeostasis, patients with chronic kidney disease (CKD) almost always have mineral and bone disorder "CKD-MDD".As CKD progresses, PTH level increases due to altered 1,25-dihydroxyvitamin D (calcitriol) metabolism, hypocalcemia and hyperphosphatemia. Control of metabolic derangements related to bone disease is one of the important goals in management of patients with CKD.The objective of this study was to compare the efficacy of a cinacalcet-based regimen, HDF with unrestricted conventional care (vitamin D and phosphate binders) for achieving the stringent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) targets for dialysis patients.This study was performed on 33 children with ESRD on regular hemodialysis. All children subjected to full history taking, thorough clinical examination and laboratory investigations (e.g.: intact PTH).Cinacalcet resulted in significant decrease in alkaline phosphatase and PTH levels compared to pre-treatment levels (p value 0.045 and 0.003 respectively) and significant increase in hematocrit level. Hemodiafiltration resulted in similar effects of cinacalcet.Significant percent of patients on cinacalcet and HDF, compared to patients on conventional treatment, achieved the target PTH level ≤300pg/ml (54.5%, 61.5% and 22.2% respectively) and this achieve NKF/DOQI guidelines.