Anemia is common and contributes to many of the symptoms associated with uremia in children with CKD. While the use of recombinant human erythropoietin has dramatically improved the management of renal anemia, a significant number of patients remain resistant or hyporesponsive despite adequate iron stores. Hepcidin has been questioned to have a role in this resistance through preventing absorption and release of iron. In this study, hepcidin was measured in the serum of 19 children on hemodialysis (HD), 20 with stage 4 CKD and 20 controls. Hepcidin was elevated in children with CKD; the more advanced the kidney affection (lower eGFR and in those on HD), the higher the hepcidin level. Higher Hepcidin concentrations were associated with more severe anemia, less response to EPO and higher iron stores. Proving a causal relation as well as methods for correcting inappropriately high hepcidin levels need further study.