Cutaneous manifestations of ESRD are a common occurrence world wide due to the rising number of patients with ESRD. A high prevalence of cutaneous manifestations is expected, since most patients with ESRD have an underlying disease process with cutaneous manifestations. In addition, uraemia and conditions associated with renal replacement therapy are fraught with numerous and often relatively unique cutaneous disorders. The study aimed to assess the relevance of skin lesions as surrogate markers of renal disease among patients in Lagos. MATERIALS AND METHOD Study cases were randomly selected adult patients aged 15 years and above who fulfilled the inclusion criteria and presented at LUTH, Life support and St Nicholas Hospital Lagos, with a diagnosis of ESRD (GFR < 15mls/min) and renal transplant patients. The study period was from August 2006 to June 2007. Control subjects were non – renal, non- hypertensive and non- diabetic patients of the medical wards of LUTH, with CKD stage 0, GFR of > 90mls/min. Ethical clearance was obtained from all the health institutions utilized. Patients were evaluated clinically for cutaneous manifestations of ESRD and laboratory investigations including packed cell volume, calcium,phosphate, electrolyte, urea and creatinine, urineanalysis,Hepatitis B surface Antigen and Hepatitis C Antibody tests. Data was analysed using Epi info 2002 statistical software. RESULTS The mean age for subjects was 45.4± 14.9 years and controls 45.6 ± 13.3 years. Comparison of the blood pressure, packed cell volume, creatinine clearance, serum calcium and phosphate between cases and controls was statistically significant. Majority of the ESRD cases were on haemodialysis, with most cases having it for just one year. The prevalence of cutaneous manifestations of ESRD was high in Lagos metropolis. General skin changes were the most prevalent cutaneous manifestation, with xerosis being the commonest. General skin changes were high in all the three treatment categories. Hypertension could be a risk factor for xerosis, steroid use for pallor and steroid acne and gender for hypertrichosis and viral infections. CONCLUSION Cutaneous manifestations of ESRD in Lagos metropolis is common, with xerosis being the commonest manifestation