Objective: This research was conducted in an observational method with a cross-sectional design. A total of 97 MHD patients who were regularly undergoing dialysis twice per week at Sleman Regional Hospital, Indonesia were recruited during January-February 2021. Fatigue was assessed using a-13-items of Functional Assessment Chronic Illness Therapy (FACIT) scale; the result was categorized into mild (scored >30) and severe ( ≤30). Data collection involved patient’s characteristics, Nutritional status (Anthropometric data, hemoglobin, albumin, Handgrip Strength (HGS), and Dialysis Malnutrition Score (DMS)), nutrient intake, Total Iron Binding Protein (TIBC). Independent t-test and chi-square tests were performed to analyze the dependent variables. Methods: A total of 56.7% of patients were malnourished based on DMS. Severe fatigue experienced by 37.1% of patients, which more frequent in woman, the elderly, patients who were actively working, married, and gaining >5% of Inter-dialytic weight. Regarding nutritional status, Body Mass Index, HGS demonstrated a significant association to fatigue (p=<0.05), however patients with severe fatigue were found to had lower Mid Upper Arm Circumference (25.9±4.6 vs 22.6±7.6; p=0.008). Patients’ daily protein, carbohydrate, and fat intake significantly different in the two fatigue groups (p=<0.05), nevertheless, patients with mild fatigue consumed higher energy intake compared to others (1158.4±304.2 vs 1027.8±340.9; p=0.061). No significant association was found in Albumin level, TIBC, Iron serum, hemoglobin.  Results: Nutritional status and nutrient intake are relatively correlated with fatigue in MHD patients; identifying patients who are at increased risk for fatigue may result in more precise nutrition intervention with a better outcome. Conclusions: Objective: Maintenance hemodialysis (MHD) patients often experience fatigue; it becomes more profound on dialysis days which prevalent in more than 60% of dialysis patients worldwide. Fatigue affects patients' quality of life; moreover, it predicts cardiac events and all-cause mortality. This research aimed to identify factors associated with fatigue symptom in MHD patients at Sleman Regional Hospital, Indonesia Methods: This research was conducted in an observational method with a cross-sectional design. A total of 97 MHD patients who were regularly undergoing dialysis twice per week at Sleman Regional Hospital, Indonesia were recruited during January-February 2021. Fatigue was assessed using a-13-items of Functional Assessment Chronic Illness Therapy (FACIT) scale; the result was categorized into mild (scored >30) and severe ( ≤30). Data collection involved patient’s characteristics, Nutritional status (Anthropometric data, hemoglobin, albumin, Handgrip Strength (HGS), and Dialysis Malnutrition Score (DMS)), nutrient intake, Total Iron Binding Protein (TIBC). Independent t-test and chi-square tests were performed to analyze the dependent variables. Results: A total of 56.7% of patients were malnourished based on DMS. Severe fatigue experienced by 37.1% of patients, which more frequent in woman, the elderly, patients who were actively working, married, and gaining >5% of Inter-dialytic weight. Regarding nutritional status, Body Mass Index, HGS demonstrated a significant association to fatigue (p=<0.05), however patients with severe fatigue were found to had lower Mid Upper Arm Circumference (25.9±4.6 vs 22.6±7.6; p=0.008). Patients’ daily protein, carbohydrate, and fat intake significantly different in the two fatigue groups (p=<0.05), nevertheless, patients with mild fatigue consumed higher energy intake compared to others (1158.4±304.2 vs 1027.8±340.9; p=0.061). No significant association was found in Albumin level, TIBC, Iron serum, hemoglobin.  Conclusions: Nutritional status and nutrient intake are relatively correlated with fatigue in MHD patients; identifying patients who are at increased risk for fatigue may result in more precise nutrition intervention with a better outcome.