Background <p>Chronic kidney disease (CKD) is a relatively uncommon disease in children. A child's nutritional status indicates how well their body is getting the required nutrients. This research aimed to determine the nutritional state of hemodialysis-treated children with end-stage kidney failure.</p> Patients and Methods <p>A case group of 50 children with kidney failure undergoing hemodialysis was compared with a control group of 50 healthy children of the same age. A structured interview questionnaire was used with the children or their mothers, covering nutritional assessment, physical examination, anthropometric measurements, and lab tests. Dietary intake was evaluated through 24-hour recalls, and each case’s dietary consumption was analyzed, followed by nutritional education. Children were reassessed after a 6-month follow-up.</p> Results <p>Most children with kidney failure initially had height and weight below the 5th percentile, with Mid Upper Arm Circumference (MUAC) below -3 SD. Dietary recall initially revealed low caloric intake (p = 0.046), high sodium (p = 0.06), high potassium (p = 0.01), high phosphorus (p &lt; 0.01), and low calcium (p &lt; 0.009) compared to controls. By study’s end, MUAC and weight percentiles improved (p = 0.045 and 0.039). Lab results showed significant decreases in urea (p = 0.005), creatinine (p &lt; 0.001), sodium (p &lt; 0.001), potassium (p = 0.001), uric acid (p &lt; 0.001), phosphorus (p= 0.04), and parathormone (p = 0.03) from baseline.</p> Conclusion <p>Our study suggests that appropriately targeted nutrition education in children with CKD can improve weight centiles and MUAC and deranged renal biochemistry (including low serum albumin and raised serum potassium).</p> Graphical abstract <p></p>