Background: Anemia is a deleterious complication of end stage renal disease (ESRD). It is highly prevalent in sub-saharan Africa. The predictors of control of hemoglobin levels in ESRD patients in Sudan are unknown. Methods: A prospective observational study was conducted to evaluate the prevalence of anemia and factors affecting the control of hemoglobin levels in ESRD patients. A standardized data collection form was used for collecting patient information. A total of 1015 hemodialysis patients were recruited from twelve centers. Results: The 534 (52.6%) patients were included in the final analysis. Those were excluded, including, 194 (19.1%) patients were transferred to other centers before completion of the study, 165 (16.3%) died, 38 (3.7%) underwent renal transplantation and 84 (8.3%) were lost to follow-up. Among the patients who included in the final analysis, 307 (57.5%) were males and the mean age was 48.7±16.1 years. All the analyzed patients were anemic (hemoglobin level<12 g/dL), 67% had a hemoglobin level <10 g/dL. In multivariate analysis the variables which had statistically significant associations with hemoglobin levels equal or higher than 10 g/dL were insured patients [OR = 1.53, 95% CI (1.04–2.25)]; and two drug combinations: "Erythropioesis simulating agent (ESA), intravenous (IV) iron, oral iron, and vitamins" [OR = 1.87, (1.27–2.76)] and "ESA, oral iron and vitamins" [OR = 6.67, (2.98–14.94)]. While, a family history of ESRD [OR = 0.57, (0.35–0.94)] and duration of hypertension for "6-9 years" [OR = 0.47, (0.25–0.87)]; Female patients were identified as being more likely to have lower hemoglobin in both univariate and multivariate analyses. Conclusion: There was suboptimal treated anemia requiring attention in this population. Patients with a family history of ESRD and duration of hypertension for "6-9 years" were predicted to have lower hemoglobin levels. More concern should be paid to uninsured patients and anemia drugs, including the ESA and iron preparations. The results of this study increase our knowledge about the prevalence of anemia and the factors that contribute to control of hemoglobin levels in Sudan. Keywords: Prevalence, Anemia in ESRD, Hemodialysis, Erythropioesis Stimulating Agents, Hemoglobin Level, Health Insurance, Hypertension, Family History of ESRD, Sudan, Khartoum.