Chronic kidney disease (CKD) affects more than 19 million people in the United States, and prevalance of CKD is expected to double within 10 years. Additionally, a significant number of predominantly elderly patients have end stage renal disease, necessitating dialysis or kidney transplant. Perception of chronic pain, especially in elderly dialysis patients, may be greatly underrecognized. As a result management of pain, as well as depression, and other physical and mental symptoms, may not be adequately addressed in the primary care setting. Clinical interventions such as psychiatric evaluation, pain management, and therapy to improve physical and mental symptoms, may markedly impact wellbeing for CKD patients. Constant reassessment is critical when treating CKD patients. Such an approach may significantly better elderly patients health-related quality of life.