Background: Maintenance hemodialysis (MHD) is the primary treatment for end-stage renal disease (ESRD), but it is associated with significant metabolic disturbances. Serum phosphate, calcium, and parathyroid hormone (PTH) imbalances contribute to chronic kidney disease-mineral and bone disorder (CKD-MBD), which increases morbidity and cardiovascular risks. Understanding the relationship between these biochemical parameters and metabolic disturbances is crucial for improving patient management. Aim: To assess the relationship between serum phosphate, calcium, and PTH levels with metabolic disturbances in MHD patients in Bangladesh. Methods & Materials: A cross-sectional study was conducted at Dhaka Medical College Hospital with 80 MHD patients. Clinical and biochemical data, including serum phosphate, calcium, iPTH, and lipid profiles, were analyzed using SPSS (version 26). Correlation analysis was performed to examine associations between metabolic disturbances and biochemical markers. Results: Mean serum phosphate, calcium, and iPTH levels were 5.56±1.36 mg/dl, 8.74±1.30 mg/dl, and 274.59±150.34 pg/ml, respectively. Significant correlations were found between metabolic disturbances and serum phosphate (r=0.652, p<0.001), iPTH (r=0.725, p<0.001), and LDL-C (r=0.382, p=0.008), while serum calcium showed a negative correlation (r=-0.320, p=0.012). Conclusion: Hyperphosphatemia, secondary hyperparathyroidism, and dyslipidemia contribute to metabolic disturbances in MHD patients. Effective biochemical management is crucial for improving patient outcomes. Further studies with larger cohorts are recommended to validate these findings.