Correa S, Pena-Esparragoza JK, Scovner KM, et al. - Given that adverse symptoms are seen in most patients on maintenance hemodialysis (HD) resulting in reduced quality of life, so, researchers used a prospective cohort study design to investigate modifiable patient- and HD-associated predictors of intradialytic symptoms. From the Hemodialysis Trial, they leveraged patient-level (n = 1,838) and HD session–level (n = 64,797) data. In 10.7% of HD sessions, the occurrence of symptoms was evident. Higher adjusted odds of muscle cramping and lightheadedness were observed in relation to higher pre-HD serum urea nitrogen (SUN) level (per 10 mg/dL). Greater risk for muscle cramping, headache, chest pain, vomiting, and lightheadedness was evident in relation to systolic blood pressure (SBP) reduction (from the predialysis value to the dialysis session nadir, per each 10–mm Hg decrease). Greater odds of cramping were reported in relation to higher ultrafiltration rate (UFR) (per 1 mL/kg/h), and conversely, higher pre-HD SBP (per 10 mm Hg) was identified to be related to decreased risk for vomiting and lightheadedness. Overall, the independent link of higher pre-HD SUN level, UFR, pre-HD SBP, and SBP decline, with distinct patterns of adverse intradialytic symptoms, was evident in this study.