Purpose: To evaluate the effect of a salivary phosphate binder "Chitosan" in a chewable form on serum and salivary levels of phosphate, calcium and urea in a group of hyperphosphatemic, hemodialysis pediatric patients suffering from end stage renal disease. Subjects and Methods: The study comprised 30 children on hemodialysis; (14 males and 16 females), aging 7-16 years, selected from the hemodialysis units of Al-Azhar University Hospitals. All the children chewed chitosan loaded chewing gum for one hour, twice daily, during the fasting hours between meals throughout the trial period (3 months), while maintained on oral phosphate binders. Results: There was a statistically significant decrease in the mean serum levels of phosphate and urea as well as an increase in serum calcium means levels. There was a significant decrease in mean levels of salivary phosphate and urea and increase in mean levels of salivary calcium. Conclusion:Chitosan loaded chewing-gum can be safely and effectively used for management of hyperphosphatemia in hemodialysis pediatric patients, as an addition to the oral phosphate binders.