CKD is a globally important public health problem, which leads to end-stage renal disease (ESRD) and increases the risk of morbidity and mortality . 1 The prevalence of CKD in general populations is 11-13% worlidwide. 2 In Egypt the highest percentage of patients with CKD (31.9%) was found to be between 50 and 60 years. 3 Patients with CKD have a higher prevalence of cognitive dysfunction than the general population even when accounting for other risk factors such as age, diabetes,

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... r risk and other comorbidities. 4 Cognitive impairment impacts patients negatively by contributing to functional dependence and behavioral symptoms that result in poor outcomes and decreased medication and medical care compliance. These negative consequences result in a downward spiral of functional decline and an accelerated loss of independence, which leads to premature Abstract Background: Chronic kidney disease (CKD) and cognitive impairment are important and prevalent public health problems that lead to increase the risk of morbidity and mortality. Both are considered a major social and financial burden. Cognitive impairment commonly occurs in individuals with CKD; therefore cognitive assessment is extremely important. Early diagnosis and interv ention help to decrease the progression of cognitive impairment. Aim: To identify the relation between serum creatinine level and estimated glomerular filtration rate (e -GFR) and global cognitive function (Mini Mental State Examination (MMSE) score in Egyp tian elderly with CKD stages 2 -4 with normal muscle mass. Methods: Cross-sectional study was conducted at the Geriatrics in -patient wards and outpatient clinics at Ain Shams University Hospitals, Cairo, Egypt, over six months. Fourty five elderly patients who had CKD stages 2 -4 with normal muscle mass index were included in the study. Muscle mass was assessed using Bio Electrical Impedance analysis (BIA). History was taken from all participants followed by assessment of the global cognitive function by MMSE , measurement of the serum creatinine level and e -GFR by 24 hours urinary creatinine clearance. Results: There was a significant negative correlation between serum creatinine level and MMSE score, and a significant positive correlation between e -GFR and MMSE score. By regression analysis of possible confounding factors, only e-GFR not serum creatinine level shows a significant correlation with MMSE. Conclusion: e-GFR not serum creatinine level is associated with a lower MMSE score in elderly despite having normal muscle mass.