Background: In pediatric Patients under regular hemodialysis, iron supplementation is essential for optimal response to erythropoietin therapy. Oral iron supplementation may be insufficient to maintain total body iron stores in children under regular hemodialysis, and intravenous (IV) iron supplementation might be an effective alternative but with variable safety of different preparations. Objectives: To evaluate the effects of maintenance IV iron sucrose versus oral iron gluconate on iron indices and hematological profile in pediatric hemodialysis patients and reporting the safety of both preparations. Methods: A cross over study was made on 16 children under regular hemodialysis (12 males and 14 females with median age 11 years) who had initial adequate iron stores as evidenced by serum transferrin saturation ≥ 20% and/or serum ferritin ≥ 100 ng/ml. They were maintained on oral iron gluconate in a dose of 3 mg/kg/daily and erythropoietin alpha (EPO) therapy in a dose of 50 IU/kg/IV 3 times weekly for 3 months. Then a shift from oral to IV iron sucrose in a dose of 2 mg/kg/every 2 weeks in addition to EPO in the same previous dose and route was made for another 3 months. Results: We Reported significant changes between baseline follow-up investigations as follows: serum ferritin (median 345-505 ng/ml, P = 0.002), transferrin saturation (median 36.1-58.2%, p = 0.001), hemoglobin concentration (median 8.8 -9.5 gm/dl, p = 0.021), and hematocrit (median 28.5-31.7%, p = 0.002). Conclusions: We concluded that hemoglobin and hematocrit were significantly increased by (8%) and (11.2%) respectively in response to IV maintenance iron sucrose every 2 weeks. In addition, IV iron sucrose can be safely used as a maintenance preparation in children under regular hemodialysis to maintain adequate iron stores and response to EPO therapy with no or little increment in its doses.