Objective To understand the current status of symptom distress among young and middle-aged patients on peritoneal dia-lysis therapy, to analyze the influencing factors, and to provide references for developing personalized interventions to alleviate symptom distress.Methods A convenience sampling method was used to select 303 young and middle-aged peritoneal dialysis patients who were followed up regularly in the peritoneal dialysis centers of the Nephrology Department of three tertiary hospitals in Shanghai from November 2022 to June 2023.Data were collected using a general information questionnaire, the Peritoneal Dialysis Symptom Distress Scale, and Brief Illness Perception Questionnaire and so on.Results The incidence of symptoms in young and middle-aged patients on peritoneal dialysis ranged from 15.84% to 73.27%, with fatigue being the most common symptom (73.27%).The symptom distress score was 21.96±9.79, indicating a relatively low level of distress.Multiple stepwise linear regression analysis demonstrated that illness perception, psychological resilience, volume management behavior, coping styles (confrontation and avoidance), employment status, medical expense payment mode, dialysis years, and Charlson Comorbidity Index were significant influencing factors of symptom distress (all P＜0.05).Conclusion Symptom distress among young and middle-aged patients on peritoneal dialysis is relatively low but influenced by multiple factors.Healthcare providers should develop perso-nalized symptom management strategies based on modifiable factors to alleviate patients′ symptom distress.