When Congress was considering extending Medicare coverage to those with chronic renal failure, it was predicted that 100% of these individuals would be vocationally active. Unfortunately, the actual vocational rehabilitation rate for this population is much below these earlier predictions. A comprehensive review of the literature establishes that there are variables that affect the employability of those on dialysis. These variables can be grouped into four main categories: demographic, psychological, medical, and occupational. In addition, there are barriers to enhanced vocational rehabilitation for individuals receiving dialysis therapy, and these can be grouped accordingly: workplace, financial, dialysis facility/personnel, vocational rehabilitation, and labor market. Enhanced research efforts, intervention with employers and vocational rehabilitation programs, changes within the Social Security system, and modification of renal team practices could all serve to enhance the vocational rehabilitation status of individuals with chronic renal failure.