Anemia, a common complication of end-stage renal disease, is associated with elevated morbidity, mortality, and health care costs. A primary cause of anemia in end-stage renal disease is iron deficiency, particularly among patients requiring Hemodialysis. Therefore, the purpose of this study was to determine if IV iron maintenance treatment is helpful for avoiding anaemia in children with ESRD. Methods: This study is a randomized clinical trial and was carried out at Pediatric Dialysis Unit from March 2021 till September 2022. Results: there was statistically significant difference between the studied groups as regard Hb, MCH, MCHC, serum iron and TSAT at the end of the study. Conclusion: IV iron maintenance therapy along with ESAs in children with ESRD who were undergoing regular HD was beneficial for maintaining hemoglobin levels and reducing the risk of anemia. This therapy should therefore be considered for this patient group. However, iron supplementation for patients with hyperferritinemia is a challenging issue because the high serum ferritin level may not confirm iron marker overload. Hence, the decision to start IV iron maintenance therapy in patients with hyperferritinemia should follow a holistic approach, taking into consideration the patient's clinical condition and morbidity.