Abstract : A common medical condition in Iraq is chronic kidney disease. Anemia seems to be a serious complication of chronic kidney disease which can be attributed to many factors. The introduction of Erythropoiesis stimulating agents (ESA) has made a dramatic change in the management of renal anemia; however, low sensitivity to Erythropoiesis stimulating agents or increase dose required has been noted in a considerable proportion of ESA receiving patients and it has been linked to adverse outcomes. Vitamin D3 deficiency has a main role in the pathogenesis of CKD; the studies have shown a pleotropic effect of vitamin D3 as anti- inflammatory agent beyond its critical role in calcium homeostasis. Two groups as below to be enrolled in this study for three months divided as: Group A: 20 patients with end stage renal disease (ESRD) on regular hemodialysis will receive only epoitinalpha 4000 IU twice weekly. Group B: 20 patients with ESRD on regular hemodialysis will receive epoitin alpha 4000 IU twice weekly plus 50,000 IU/week of nutritional vitamin D3 for ten weeks. The results in this study showed the treatment group has significant increase in vitamin D3, Hb and (p≤0.05) but significant decrease (p≤0.05) in ERI. While the result of control group showed not significant change in Hb and ERI but significant decrease (p≤0.05) in vitamin D3. Restoration vitamin D3 to the normal level could be occur by administration 500000IU accumulative dose of vitamin D3 supplement and this increasing may influence on reducing the dose of ESA needed or hypo responsiveness and improving of anemia state for the hemodialysis patients.