<p>Pain is a common and burdensome symptom in patients with end-stage kidney disease undergoing dialysis, yet it often remains underrecognized and undertreated. This multicenter nationwide cross-sectional study assessed the prevalence, characteristics of pain, identified factors associated with the presence of pain and moderate-to-severe pain among patients receiving dialysis, and evaluated current pain management practices. A total of 1,596 patients undergoing maintenance dialysis from 99 centers across Poland completed a standardized questionnaire assessing pain intensity and psychosocial factors. Clinical and sociodemographic data were collected. Multivariable logistic regression was used to identify factors associated with (1) the presence of pain in the overall study population and (2) moderate-to-severe pain (Numerical Rating Scale [NRS] ≥ 4) versus mild pain (NRS 1–3) among the 1,114 participants who reported pain. Pain during the previous week was reported by 70% of participants, with a median intensity of 5 on the NRS. Musculoskeletal pain (64%) and headaches (35%) were the most common complaints. In multivariable analysis, pain was independently associated with dialysis disequilibrium syndrome, secondary hyperparathyroidism, intradialytic hypotension, muscle cramps, restless legs syndrome, higher anxiety levels, and longer dialysis vintage. Moderate-to-severe pain was associated with a greater number of dialysis complications, neuropathic symptoms, higher anxiety scores, and longer dialysis vintage. Despite experiencing pain, 30% of patients did not use analgesics and only 17% reported regular analgesic therapy. Pain is highly prevalent among patients undergoing dialysis and is associated with dialysis-related complications, neuropathic symptoms, and psychological distress. Routine pain assessment should be integrated into nephrology care to enable individualized management and reduce symptom burden.</p>