Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP-Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between the CRP-Alb ratio and skeletal muscle mass normalized for body weight (SMM/wt; estimated using a bioelectrical impedance analyzer) was investigated. The mean age of the study participants was 54.9 ± 6.6 years (ranging from 27 to 64 years); 43 (47.2%) were men. The mean values for the SMM/wt were 39.1% ± 5.4%. The CRP-Alb ratio was found to be negatively correlated with SMM/wt (r = -0.33, P = 0.002) and creatinine (r = -0.20, P = 0.056). All the univariate significant and nonsignificant relevant covariates were selected for multivariable stepwise regression analysis. We determined that the homeostasis model assessment-estimated insulin resistance and CRP-Alb ratio were independent risk determinants for SMM/wt (βHOMA-IR = -0.18 and βCRP-Alb ratio = -3.84, adjusted R2 = 0.32). This study indicated that the CRP-Alb ratio may help clinicians in predicting muscle mass in adult patients undergoing HD.