The children with stage5 chronic kidney disease is increasing, and they are experiencing various complications, with renal osteodystrophy (secondary hyperparathyroidism) being the most significant. Objective: To identify the incidence of renal osteodystrophy in end –stage kidney failure pediatric patients on maintains Hemodialysis visiting at pediatric dialysis units, Tripoli University Hospital, Tripoli, Libya. Methodology: 23 pediatric patients followed up at the hospital with diagnosis of Chronic Kidney Disease (CKD) stage 5 on hemodialysis of the age between 1 to 18 years (11 girls and 12 boys) were involved in the study. Multiple biochemical markers of renal osteodystrophy were included (serum calcium, phosphorus, Parathyroid Hormone (PTH), Alkaline Phosphatase (ALP), Vitamin D), which is collected from medical files of patients. All pediatric patients were assessed by using biochemical marker, clinical feature and X-ray some of them, to diagnosis the presence of mineral bone diseases. Results: The mean and standard deviation of age were 11.43±3.95 years. 11(47.8%) were girls and 12(52.2%) were boys. Secondary hyperparathyroidism (renal osteodystrophy) was found in 69.6% with mean values of PTH of children was 725.57±644.11. Also the mean Ca level was 8.44±0.95. High percentage of bone pain and itch presented was78.3% and 65.2% of patients, respectively, which they related to hyperparathyroidism. X-ray was conducted on selected patients to facilitate the assessment of bone diseases in children with chronic kidney diseases. In Conclusion, biochemical analysis, clinical signs and X-ray provided relatively accurate information for diagnosis and treatment. The clinical characteristic of this disease indicate that early detection could be the most effective approach to change its progression.................... Keywords. ................Osteodystrophy; hyperparathyroidism; haemodialysis; bone disease; pediatric ESKD.