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. Methods: This randomized control trail (RCT) included 70 hemodialysis children, randomly classified to receive recombinant HB vaccine with two different protocols:the augmented four dosing protocol and the standard three dosing protocol. Anti-HBs titers assessed one month after last vaccine dose. Predictive variables that can affect the immune response were assessed using multivariate analysis. Results: HD children who received augmented vaccine dosing had significantly higher seroprotection rate (94.3% had HBsAb>100 mIU/mL) than children who received standard vaccine dosing (77.1% had HBsAb > 100 mIU/mL) with significant difference (p= 0.028). Dose of HB vaccine (95.0% CI, 0.645; 6.685) and serum phosphorus (95.0% CI, -35.320;-2.611) are independent factors affecting the postvaccination titer. Conclusion: Augmented HB vaccine approach induced higher immune response in children on hemodialysis. Keywords: Hepatitis B virus, vaccine, Dose, hemodialysis, children