Malnutrition is common in dialysis patients and is attributed to decreased food intake, and/or chronic systemic inflammation linked to dialysis-related comorbidities and complications. This study aimed to determine the prevalence of gastrointestinal (GI) symptoms in dialysis patients and whether this impacts food intake. DESIGN: Cross-sectional study. SETTING: Tertiary teaching hospital. PARTICIPANTS: All consenting hospital peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS: Patients were interviewed by a dietitian regarding the prevalence and impact of GI symptoms (nausea, vomiting, bloating, early satiety, diarrhea, heartburn, fatigue, and weight changes). Serum levels of albumin were measured, and the use of medication known to cause GI symptoms was recorded. MAIN OUTCOME MEASURE: Presence of GI symptoms. RESULTS: The PD (n = 122) and HD (n = 172) groups were similar in age, gender, and presence of diabetes. Serum albumin levels were lower for those on PD compared with HD (3.2 vs. 3.5 g/dL, P <.001). Eighty-five percent of the patients on PD reported at least 1 GI symptom, compared with 51 on HD. Compared with HD, more PD patients reported that GI symptoms were related to the onset of dialysis (55 vs. 12 , P <.001). A greater number of PD patients (compared with HD patients) reported a decrease in food intake (53 vs. 14 , P <.001) and that they had attempted dietary changes to alleviate symptoms (34 vs. 9 , P <.001). CONCLUSION: These results should influence dietetic educational practice. In addition to the provision of adequate protein and energy, dialysis patients should be counselled regarding the management of GI symptoms and monitored for the prevalence and severity of these symptoms.