Background:Multiple factors contribute to the increased risk of malnutrition among patients on hemodialysis, which may lead to poor clinical outcomes and increased risk of morbidity and mortality. The objective was to assess the nutritional status among hemodialysis patients using different nutritional assessment tools and to assess their agreement. Methods: A cross-sectional study was conducted among 125 patients on hemodialysis at Zagazig university hospital, in Egypt. Nutritional assessment tools included the Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), and Malnutrition Inflammation Score (MIS). Nutritional assessment was done by the three tools. Results: The average age was 48.02±13.15 years and 49.6% of the patients were males. The average body mass index was 23.12±3.98 kg/m2. The main reasons for hemodialysis were hypertension (40.0%) and diabetes mellitus (17.6%). Based on SGA, MNA, and MIS tools, 20.8%, 18.4%, and 20% were severely unnourished, respectively. Additionally, 47.2%, 48.0%, and 46.4% had mild to moderate malnutrition. There was statistically significant agreement among different methods (P<0. 0001). The kappa values further support this good agreement. Agreement between SGA and MNA was strong (κ=0.936, p<0.001). Agreement between SGA and MIS was very strong (κ=0.962, p<0.001). Agreement between MNA and MIS was also strong (κ=0.898, p<0.001). Conclusions: Malnutrition is very prevalent among hemodialysis patients using three different methods of nutritional assessment, affecting more than 65% of them, including about 20% severe malnutrition. The strong agreement between the three tools suggests that they can be used interchangeably.