The interviews used open-ended questions, such as``How has kidney disease requiring dialysis affected your quality of life?'' Two coders independently reviewed the interview transcripts to identify themes, resolving disagreements by consensus. Themes were compared within and across subjects to identify and organize important concepts. Subjects were enrolled until the point of thematic saturation, when further interviews revealed no new themes. RESULTS: The 27 subjects interviewed had a mean(SD) age of 747 years and had been on hemodialysis for an average of 3.53.1 years. They identified five domains important to QOL: symptoms, burdens of treatment, benefits of treatment, information needs, and relationships with providers. The most common symptoms reported were fatigue, balance problems, weakness, cramps, itching, and nausea. Burdens of treatment included time spent at dialysis, difficulty traveling, problems with vascular access, and giving things up. Benefits of treatment included relief of symptoms, social interaction, and enhanced access to health care providers. Subjects noted the importance of adequate information about how to care for themselves and what symptoms or problems to expect, and of competent and caring providers who treat them with respect and acknowledge their individuality. Symptoms and burdens of treatment affected QOL negatively and benefits of treatment affected QOL positively, while the remaining domains could have either positive or negative effects. The magnitude of these effects was influenced by non-medical factors, such as social support, family relationships, formal instrumental support, finances, and spirituality. Subjects universally noted the necessity of dialysis for sustaining life, and preferred even a low QOL on dialysis to death. CONCLUSION: When asked about their perspectives, older hemodialysis patients, while acknowledging the necessity of dialysis, identified a variety of domains important to their QOL as dialysis patients. Several of these domains, particularly information needs and the benefits of treatment, are not found in existing generic or renal-specific QOL scales. In developing such scales, it is important to elicit the factors most important to patients and ensure that these are included.