Pain is a multidimensional phenomenon with physical, psychological, and social components and is a significant problem for 50% of hemodialysis (HD) patients. Failure to treat pain adequately may lead to disruption in many aspects of life. This study examines the relationship between moderate to severe chronic pain and depression, insomnia, and the desire to withdraw from dialysis in HD patients. In a cross-sectional study of 205 Canadian HD patients, patients completed a questionnaire that included the Brief Pain Inventory, Beck Depression Inventory, and the Pittsburgh Sleep Quality Index. One hundred and three patients (50.2%) reported chronic pain and 85 (41.4%), moderate to severe pain. There was a higher prevalence of depression in patients with moderate or severe chronic pain compared to patients with mild or no pain (34.1% vs. 18.3%, odds ratio [OR]=2.31, P=0.01). Severe irritability, anxiousness, and inability to cope with stress were all more common in patients with pain compared to patients without pain (P<0.001). There was a higher prevalence of insomnia in patients with moderate or severe chronic pain compared to patients with mild or no pain (74.7% vs. 53.0%, OR=2.32, P=0.02). Although consideration of withdrawal from dialysis was significantly associated with moderate or severe pain compared to no or mild pain (46% vs. 16.7%, P<0.001), death due to withdrawal from dialysis was not. Chronic pain in HD patients is associated with depression and insomnia and may predispose patients to consider withdrawal of dialysis.