Back ground: The risk of fractures progressively increased with kidney function declines and in end-stage the kidney disease regarded as the risk of fractures is more 2 to 3 times higher compared to the general population. The gold standard for assessment of bone turnover is the measurement of bone formation rate in an iliac crest bone biopsy specimen. This is limited by expense, invasiveness and availability of local expertise. Plasma bone turnover markers were developed in osteoporosis patients for fracture risk prediction and assessment of medication compliance and anti-fracture efficacy