In dialysis patiants, Chronic Kidney Disease-Mineral and Bone Disorder;CKD-MBD is the most important complication associated with vital prognosis. From the view of vital prognosis, the Medical Guidelines of CKD-MBD references the treatment and adjusting the medicine to keep the serum P, Ca, and PTH level. In the patients undergoing hemodialysis, composition of dialysate influences bone and Ca metabolism. Ca concentrations of dialysate is recommended 2.5-3.0 mEq/L in Japan, but it is important that we select the dialysate considering presence of complications and the meal and the medicines. And It is related to critical prevention and suppress the progression of CKD-MBD.