ABSTRACT Symptom and quality of life (QOL) measures in patients with advanced chronic kidney disease are recognized indicators of patient‐centred care and represent important research, quality and clinical measures. This study examined relationships between symptom burden, QOL and functional status and associations of symptoms and mortality risk. A multisite longitudinal cohort analysis was undertaken in chronic kidney disease stage 4/5 (no dialysis) and dialysis patients. Patients completed symptom and QOL measures (Palliative Care Outcome Symptom Score renal), World Health Organisation QOL Brief Version) and Karnofsky Performance scale. Clinical and demographic data were recorded. SUMMARY AT A GLANCE Symptoms in patients with advanced kidney disease are common and are associated with reduced quality of life, health satisfaction and functional status. In addition to this, this study shows symptoms are associated with increased risk of mortality over 12 months suggesting a novel approach to consider symptoms in prognostic assessments.