Background: Patients undergoing hemodialysis (HD) frequently experience malnutrition, and this condition has strong causal relationship with mortality risk. Patients on hemodialysis typically use both the Geriatric Nutritional Risk Index (GNRI) and the Creatinine Index (CI) for evaluation of their nutritional status. Objective: To compare CI and GNRI for evaluation of malnutrition in elderly hemodialysis patients. Methods: This study included 60 patients aged ≥65 years on maintained hemodialysis who attended Hemodialysis Unit of Alexandria Main University Hospital. Full clinical assessment and routine laboratory investigations were done. Anthropometric measurements were estimated. Nutritional assessment using CI, GNRI, and Short Form Mini Nutritional Assessment. Cognitive function was evaluated using MMSE (mini mental status examination), Get up and Go Test (GUGT), (ADL), and (IADL) were assessed.  Results: 43.3% had normal nutrition, 33.3% at risk of malnutrition and 23.3% had malnutrition. BMI, hemoglobin and serum albumin were significantly lower in at risk and malnutrition groups but cholesterol, triglycerides and ESR were significantly higher in at risk and malnutrition groups. GNRI, CI and were significantly lower in at risk and malnutrition groups. All severe cognitive impairment cases (57.1%) were malnourished. 35.7% of mild cognitive impairment were malnourished and 7.1% of normal cognitive functions cases were malnourished. 38.3% had impaired instrumental activities of daily living (IADL), 26.7% had impaired activities of daily living (ADL) and 65% were at risk of falls. Conclusion: GNRI is easy screening scoring tool for identifying the risk of malnutrition and has higher sensitivity and specificity compared to CI in hemodialysis elderly patients.