Background: Patients with advanced chronic kidney disease (CKD) experience a high burden of symptoms comparable to cancer patients. Symptoms vary widely depending on age and comorbidities and tolerance thresholds. Complaints include symptoms related to uremic toxins accumulation and reduced urine output. There is also a failed transplant population with advanced CKD (CKD-T). Objective: This study aims to compare symptom burden between advanced CKD and CKD after a failed kidney transplant (CKD-T). Patients and methods: This cross-sectional study included fifty advanced CKD patients with glomerular filtration rate (GFR) less than 30 ml/min /1.73m2 and fifty advanced CKD patients GFR less than 30 ml/min/1.73m2 after a failed kidney transplant (CKD-T) from Ain Shams University Outpatient Nephrology Clinic and a Private Nephrology Clinic. Patients were adults older than 18 years. Patients who agreed to participate were given CHOICE questionnaire for uremic symptoms. Results: The mean age of the CKD group was 47.9 ± 14.3 compared to 52.3± 8.9 years for CKD-T. Fifty percent of the groups were males. Sixty six percent had hypertension in the CKD group compared to 70 % in CKD-T group. Cardiovascular disease was 60 % in the CKD-T group and only 32 % in CKD group. In the CKD group 32 % had diabetes compared to 46 % in the other group. Only 12% of patients had an arteriovenous fistula (AVF) in CKD and 4% of CKD. Hospitalization with infection in the past two years was 13.3% in the CKD 45% in the CKD -T group<0.04. Mean urea level was 91.7 ± 12.3 in the CKD group and 84.9 ± 16.8 mg/dl in the CKD-T, p<0.035. Mean creatinine was similar in both groups 4.8 ± 0.4 in CKD group and 4.9 ± 0.3 mg/dl, p= 0.3. Fatigue was present in 73% of CKD and 70 % in CKD-T. Anorexia was encountered more in the CKD group 53 % and 45 % but this difference was not statistically significant p 0.6. Trouble sleeping was a frequent complaint in the CKD 70% as opposed to 44% in CKD-T. More patients complained of shortness of breath in CKD-T 66% versus 34 % in CKD with p <0.03. More patients in CKD group complained of reduced urine output (47%) but with no statistical significance p 0.2. Cramps and bone pain were equal in both groups. Lower limb edema was more prevalent 80 % in CKD and 60 % in CKD-T with various degrees. Conclusion: CKD symptoms were comparable between the two groups. CKD-T patients experienced a symptom burden comparable to CKD patients. Shortness of breath was more prevalent in the CKD-T group. Fatigue and nausea were associated with age more than 50 and urea level>80 mg/dl.