Background: Children with end stage renal disease (ESRD), particularly those who require hemodialysis (HD) are at high risk for hepatitis B virus (HBV) infection. Hemodialysis children have lower immune response to hepatitis B vaccine. Higher doses of the vaccine is one of multiple approaches have been used to improve immunogenicity in children on hemodialysis. The goals of this study were to compare rates of hepatitis B immune response following augmented (40 mcg) versus standard doses (20 mcg) of the hepatitis B vaccine in children receiving hemodialysis and to ascertain whether there are any variables influencing the immunological response to vaccination.