For decades, the management of end-stage kidney disease (ESKD) has been clinician-led, revolving around the monthly review to assess biochemical and hematological precision. This has focused on clearance targets, electrolyte balance, and anemia correction, leaving the more subjective, patient-centered aspects of illness, such as pain and fatigue, on the periphery. For people receiving maintenance hemodialysis, it is often these symptoms that most profoundly shape daily life. In this issue of AJKD, Fischer et al1 report findings from the HOPE Consortium Trial, offering the most detailed characterization to date of chronic pain among adults receiving hemodialysis.