The high rate of unemployment and inability to work among people with end-stage kidney disease (ESKD) receiving dialysis remains a vexing problem. It has been visited by multiple studies and commentaries in the medical literature. One of the original deliverables of the End-Stage Renal Disease Networks in the United States—going back to the 1980s—was to promote employment among people receiving dialysis. People starting dialysis have a low employment rate for a variety of reasons, with only 23%-24% of people aged 18-54 being employed at the time of dialysis initiation in one study.