Background <p>Vitamin D deficiency is common in children with chronic kidney disease (CKD) and has a subsequent effect on the osseous and extraosseous condition of those children. The aim of this work is to study the association between vitamin D level and anemia in children with end-stage kidney disease (ESKD) on regular hemodialysis.</p> Patients and methods <p>In this cross-sectional study, 89 children with ESKD receiving regular hemodialysis participated. Serum 25(OH) vitamin D and complete blood count (hemoglobin level), calcium, phosphorus, alkaline phosphatase, parathyroid hormone, iron profile, including ferritin, serum iron, transferrin saturation, and total iron binding capacity (TIBC), were measured for all patients. The included children (<i>n</i> = 89) were divided into two groups based on their 25(OH) vitamin D levels: the vitamin D deficiency group (<i>n</i> = 40) (level &lt; 20&#xa0;ng/mL) and the vitamin D non-deficiency group (<i>n</i> = 49) (level &gt; 20&#xa0;ng/mL).</p> Results <p>The vitamin D deficiency group’s serum hemoglobin levels were significantly lower than those of the non-deficiency group (<i>p</i>-value: 0.006). The vitamin D deficiency group’s erythropoietin resistance index was significantly greater than the non-deficiency group’s (<i>p</i>-value: 0.037). Serum 25(OH) vitamin D was shown to have a significantly negative correlation with ferritin (<i>p</i>: 0.032, <i>r</i>: 0.23) and a significant positive correlation with hemoglobin (<i>p</i>: 0.03, <i>r</i>: 0.22) in the study group.</p> Conclusions <p>Children with end-stage kidney disease (ESKD) on regular hemodialysis are more likely to develop anemia if they have a vitamin D deficiency.</p>