A self-administered questionnaire assessing both objective and subjective quality of life was completed by 489 end-stage renal disease (ESRD) patients in a representative sample of an entire network. Patients differed in both objective and subjective quality of life when examined as a function of treatment modality. The quality of life is similar for successful transplant and home hemodialysis patients; these patients appear to fare better than other treatment groups on both objective and subjective measures. Patients receiving staff-assisted center hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) report markedly diminished quality of life; these decrements remained after statistically controlling for nontreatment variables. Diminished quality of life was most pronounced in dialysis patients who had experienced failed transplants. All treatment groups showed some objective losses, especially loss of employment, but patients in the best rehabilitated treatment groups showed near-normal subjective quality of life. The results confirm previous reports that the subjective quality of life of ESRD patients can be nearly normal despite objective losses, but demonstrate that inadequate definition of treatment groups has led to misperceptions about the impact of transplant failure.