Background: Anemia is a common complication in Chronic kidney disease (CKD) patients. It has a multi-factorial pathogenesis. Replenishing iron stores and giving ESAs are the main lines of treatment. There is a general agreement on the optimal route for iron supplementation in ESRD patients with the IV route but there is no such agreement on the optimal route for iron supplementation in pre-dialysis CKD patients. Erythropoiesis stimulating agents (ESAs) treatment represent an economic burden and has been linked to possible cardiovascular side effects. This study amid to assessing the efficacy of erythropoietin in treatment of anemia in CKD patients. Methods: A prospective cohort study was conducted in chronic kidney disease patients who had undergone hemodialysis in Met-Ghamr hospital of nephrology from February 2019 to July 2019. Included 50 patients on maintenance hemodialysis, we tested the efficacy through comparing the efficacy low fixed ESA dose (4000 IU IV once weekly) versus high fixed dose (4000 IU IV three times weekly). We divided group into two groups, group A and group B. group A were put on a fixed dose of 4000 IU Epoetin alfa once weekly and group B were put on a fixed dose of 4000 IU Epoetin alfa three times weekly. Results: After 6 months, We found a significant difference in hemoglobin response of the two subgroups in favor of subgroup IID (P = 0.004). Conclusion: That low dose ESAs is less effective in correction of anemia in dialysis patients than high dose ESAs.