End Stage Renal Disease (ESRD) is one of the major chronic illnesses in Taiwan, and its prevalence is ranked as the second highest among Asian countries. The majority of treatments for ESRD patients include hemodialysis or kidney transplantation. Although the treatment of haemodialysis may prolong ESRD patients' lives, it also brings a variety of physical and mental distress for patients. Distress symptoms may disrupt the patients' functional status, quality of life, and even their survival rate. The symptoms of distress of ESRD usually occurred with various symptoms, rarely with one single symptom. This phenomenon is called symptom clusters. However, little research attention has been paid to the symptom cluster of hemodialysis patients. Therefore, the purposes of the study are to understand symptom distress of hemodialysis patients to use statistical analysis to derive clusters of symptoms that occurred in a group of hemodialysis. This is a cross-sectional study.