Background: Chronic kidney disease (CKD) is a serious disease with considerable health consequences. The most com-mon treatment that alleviates the symptoms and rescues the pa-tients' life is hemodialysis. The prevalence of CKD is increas-ing in the world for many reasons. An annual growth of 5-6 percent in the CKD compared to population growth has been a challenge in all countries around the world. Aim of Study: To assess the nutritional state and inflamma-tion in hemodialysis patients dialyzing through Permcath (Dou-ble Lumen Tunneled Catheter) and in hemodialysis patients di-alyzing through AV fistula. Patients and Methods: This comparative study will be con-ducted on 52 hemodialysis patients at the Memorial Souad Kaf-afi University Hospital Hemodialysis Unit, Misr University for Science and Technology. The study will span a period of six months, involving a detailed analysis of patient data to achieve the research objectives. Results: The study compared demographic, clinical, and nutritional parameters between AV Fistula and Permacath he-modialysis patients. Both groups had similar age and gender distributions, but the AV Fistula group had higher mean weight, BMI, and serum albumin levels, indicating better nutritional status. AV Fistula patients also showed longer access duration, higher hemoglobin levels, and lower inflammatory markers (ferritin and CRP) compared to Permacath patients, who ex-hibited greater malnutrition and inflammation. The Malnutri-tion-Inflammation Score (MIS) was significantly higher in the Permacath group, correlating negatively with BMI, hemoglo-bin, and albumin levels. These findings underscore the clinical and nutritional challenges faced by Permacath patients. Conclusion: The study highlights significant differences in nutritional and inflammatory status between patients undergo-ing hemodialysis via AV Fistulas and those using Permacaths. Patients with Permacaths generally exhibit higher Malnutri-tion-Inflammation Scores (MIS), indicating more severe mal-nutrition and inflammation compared to those with AV Fistulas. Additionally, key clinical parameters, including hemoglobin, serum albumin, and markers of inflammation like C-reactive protein and ferritin, are worse in the Permacath group, suggest-ing a greater burden of malnutrition and inflammatory stress. The correlation analysis further demonstrates that prolonged hemodialysis duration is associated with improved nutritional markers and better management of fluid balance, though it is also linked to higher inflammation levels. Overall, the findings underscore the importance of addressing malnutrition and in-flammation, particularly in patients using Permacaths, and sug-gest that more attention to nutritional support and inflammatory management is needed for improving outcomes in long-term dialysis patients.