The study aimed to evaluate the benefits of transferrin saturation percentage (TSAT) and serum ferritin in assessing body iron status, which can influence erythropoietin treatment in patients with ESRD. Forty end-stage renal disease patients on regular hemodialysis participated in this study. Clinical data were obtained. Serum iron, total iron binding capacity, transferrin saturation, ferritin, albumin, creatinine, and C-reactive protein were investigated. Thirty healthy people were enrolled as a control group. ESRD patients had a mean age of 45.1±13.9 years, with 60% being males. They exhibited significantly lower hematocrit (25.3±6.5%), and higher platelet (285.7±148.1x10^9/L) and WBC (9.4±3.1x10^9/L) counts compared to healthy controls (p<0.001 for each). The mean serum ferritin was (440.4±228.5 ng/mL), and high levels (≥300 ng/ml) were seen in 72.5% of patients, while 37.5% had functional iron deficiency. ESRD was associated with lower serum albumin (2.8±0.7 g/dL) and higher serum creatinine (5.7±2.4 mg/dL) levels (p<0.001 for each). In conclusion, about 72.5% of ESRD patients had high serum ferritin which was not a reliable index for iron stores and indicated an acute phase response. Combining transferrin saturation and serum ferritin showed low sensitivity in diagnosing iron status, determining iron status in only 47.5% of ESRD patients. The coexistence of anemia of chronic disorder and iron deficiency obscures the effectiveness of classical indices in assessing body iron status.