Hemodialysis is a physically stressful procedure and most of the elderly patients will have fatigue. Fatigue is a common and debilitating symptom, affecting 42–89% of end-stage kidney disease patients. It is a complex, multidimensional, and multifactorial phenomenon with huge repercussions on functioning, quality of life and elderly patient outcomes. Aim: determine the relationship between fatigue and functional status of the elderly patients on hemodialysis. Method: A descriptive co-relational design was used. Setting: This study was carried out at the hemodialysis unit at New Mansoura General Hospital in Mansoura city affiliated to the Ministry of Health. Tools: Data was collected using 4 tools, Tool I : Structured interview questionnaire sheet, Tool II: Katz and Akpom scale , Tool III: Lawton and Brady scale, Tool IV: Multidimensional Fatigue Inventory Scale (MFI-20).Results: the study revealed that about half of the studied elderly (51.8%) have high level of fatigue and there is a significant correlation between fatigue and the functional status of the elderly patients on hemodialysis. Conclusion & recommendation: The frequency of fatigue is high among hemodialysis patients. Fatigue has an effect on the functional status of hemodialysis elderly patients. Development & Implementation of Health educational programs for newly elders on hemodialysis about hemodialysis process and fatigue and its management.