In this discussion, the term ‘renal osteodystrophy’ will be used in a generic sense to include all the clinical syndromes of skeletal disease and altered calcium (Ca) and phosphorus (P) homeostasis resulting from renal failure. The skeletal pathology can include osteitis fibrosa and other features of secondary hyperparathyroidism, osteomalacia, aplastic bone disease, osteoporosis, osteosclerosis, and in children, retardation of growth. Emphasis will be placed on the manifestations of these syndromes that occur in patients on regular hemodialysis with a consideration of pathogenesis, prevention and management.