An evaluation study was conducted to test the benefit of a predialysis intervention in assisting blue-collar workers with end-stage renal disease (ESRD) to maintain employment. Patients with ESRD were recruited from a large southern California health maintenance organization. In a nonrandomized control trial, employment status among 45 ESRD patients who received a predialysis orientation program followed by in-center dialysis was compared with that of 57 ESRD patients dialyzed at community centers not providing predialysis intervention. Participants had a mean age of 50 years. Sixty-two percent of participants were men and 38% were women. The sample was predominantly Afro-American (35.8%), Hispanic (28.9%), and white (24%). Employment status was assessed prior to dialysis and at least 6 months after beginning maintenance dialysis treatments. The intervention consisted of physician referral to a licensed clinical social worker prior to the initiation of in-center maintenance dialysis treatments, social worker assessment, patient education and counseling, orientation to the dialysis unit, and follow-up care from physicians, licensed clinical social workers, and other team members. A significantly higher proportion of blue-collar workers who received the intervention continued working after beginning dialysis (46.7%) when contrasted with control group blue-collar workers who did not receive the early intervention (23.5%) (chi-squared text = 3.78, P < 0.05). Odds ratio calculations showed that blue-collar workers who received the intervention were 2.8 times more likely to continue working than control group blue-collar workers. The effectiveness of the intervention highlights the importance of early psychosocial intervention in assisting in-center hemodialysis patients in maintaining employment.