Background and objectives:Fibroblast growth factor 23 and para thyroid hormone in serum rise early during the course of chronic kidney disease in parallel with a decline in vitamin D. Elevations in fibroblast growth factor23 levels are one of the earliest manifestations of disordered bone-mineral metabolism in chronic kidney disease. Our aim was to assess the serum level of fibroblast growth factor23 among hemodialysis patients and comparing them with control group, and their relationships with parathyroid hormone, phosphate and calcium. Methods: This is a case – control design where 80 patients of end stage renal disease on regular hemodialysis were enrolled. While the 80 control participants were relatives of the patients who had no medical illnesses. Serum calcium, phosphorus, parathyroid hormone, and fibroblast growth factor23 levels were measured for both groups. Results: Diabetes mellitus was the most prevalent etiological factor for development of end stage renal disease (41.25%), hypertension was contributing to 23.75% of end stage renal disease cases. We found that whenever the value of parathyroid hormone, phosphate or calcium increase the level of fibroblast growth factor23 increases too, this increase was statistically significant and this finding was clear among all study samples including control group and also among patients group separately. Conclusions: Sufficient hemodialysis has an important role in serum measures particularly parathyroid hormone, calcium, and phosphate and fibroblast growth factor 23.