Social support is an understudied, yet important, modifiable risk factor in a number of chronic illnesses, including end-stage renal disease (ESRD). Increased social support has the potential to positively affect outcomes through a number of mechanisms, including decreased levels of depressive affect, increased patient perception of quality of life, increased access to health care, increased patient compliance with prescribed therapies, and direct physiologic effects on the immune system. Higher levels of social support have been linked to survival in several studies of patients with and without renal disease. Higher perceived spousal support among women on dialysis was linked to improved compliance and survival in subgroup analyses. Few studies have examined the impact of social support interventions in ESRD patients. Studies have been limited by small sample size, retrospective analyses, and lack of control populations. Given the potential link with survival, a large, prospective, randomized controlled trial is needed to evaluate the impact of a social support group intervention in ESRD patients.