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Aims and objectives To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end‐stage renal disease undergoing dialysis. Background Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear. Design A longitudinal descriptive qualitative study. Methods Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face‐to‐face semi‐structured interviews were conducted between July 2017 and July 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist. Results Four themes emerged from the data. The first theme “complex symptom experience” described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely “decreased physical functioning,” “changes in social functioning” and “diet and fluid restrictions.” Conclusions Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living. Relevance to clinical practice Patients perceived unique impact of symptoms on daily living. Therefore, a nurse‐led person‐centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day‐to‐day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor‐made and prioritised.

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Background Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients’ experiences is lacking. Objectives The aim of this study was to explore factors that are associated with patients’ symptom experiences. Methods The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display. Results Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously. Discussion This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients’ symptom experiences.