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The aim of this paper is to examine communication between patients with chronic kidney disease and nurses about managing pain in the acute hospital setting.While pain often accompanies chronic kidney disease, little is known about managing pain in actual clinical practice.A single group, non-comparative design was used.Research methods included observations and interviews to examine pain communication in all five adult renal units in the state of Victoria, Australia. A thematic approach was used to analyse the data.Observations and interviews were carried out with 14 nurses and 53 patients and 103 incidents of pain communication occurred during observations. Three themes were identified: complexity of pain, knowledge about pain management and contextual characteristics of the renal units. The nature of the patients' pain and effects of analgesics on the body shaped the complexity of pain in chronic kidney disease. Various causes of pain contributed to difficulties in management. Patients had acute pain from surgical procedures, in particular, phantom limb pain. They also had chronic pain arising from leg cramps, restless leg syndrome, and muscle and bone pain. Knowledge about pain management comprised the use of written resources about analgesics and information exchange among health professionals. Contextual characteristics involved the perceived urgency of pain communication and environmental stressors.The findings emphasize the need to capture dynamic processes of pain management in patients with chronic kidney disease to facilitate understandings about complex communication needs of this vulnerable group.Specific analgesic and non-pharmacological guidelines for patients with chronic kidney disease should be developed and made available in practice to facilitate effective pain management. Change champions of renal units are needed to support nurses in dedicating specified time for communicating with patients about managing pain.