Individuals with advanced chronic kidney disease (CKD) often experience symptom clusters, including fatigue, pruritus, and nausea, that precede their need to initiate dialysis and negatively affect their health-related quality of life.1 Established indicators of health or “hard” clinical outcomes such as hospitalization may not adequately reflect the symptomatic or functional aspects of living with kidney disease that patients consider most important, including quality of life and mental and physical well-being.