Despite the fact that dialysis treatment is useful in End Stage Renal Diseases (ESRD) patients for prolonging their life, the occurrence of Bone Mineral Disease (BMD) associated with an abnormal levels of serum calcium (Ca) and phosphorus (P) has been increasing, and deaths remain high. The risks in the derangement of serum Ca and P levels on BMD in patients undergoing hemodialysis (HD) have not been consistently studied in Ethiopia. Thus, our study aimed to assess serum Ca, P, and Parathyroid Hormone (PTH) levels, risks on BMD, and it's level of control in patients undergoing HD and compared the value with clinical practice guidelines of the Kidney Disease Outcomes Quality Initiative (K/DOQI). This study was a hospital-based quantitative retrospective study conducted on patients who had Ca, P, and PTH measurements from the medical record and assessed 56 patients (March 2018 to February 2022) in the dialysis center. The collected data was analyzed using SPSS software: Versions 22 computes variables by correlation and regression analysis. The finding of the study showed that patients average Ca level was 7.21, which is fairly low, and the value has decreased with the increase in hemodialysis frequency, and their relationship signified as 80.1%. In contrast to this, elevated P and PTH values were beyond the recommended KDOQ's P and PTH values. The level of P and PTH have increased with the increased HD frequency and demonstrated a very strong positive relationship signified with 84.2% and 71.2% with a frequency of hemodialysis, respectively. The increased disturbance of serum Ca, P and PTH levels noted in patients with HD in the dialysis center which appear to increase the prevalence of abnormalities of mineral metabolism in patients, and these adverse outcomes results in full-blown high-risk patients linked with metabolic bone diseases unless the conditions are aggressively managed.