Kidney disease is common in the United States. It occurs with more frequency and more complications among African Americans than in the general population. Patients with end stage renal disease (ESRD) are at that point in the progression of kidney disease where death is imminent if treatment is not performed to replace the limited kidney function. Hemodialysis is a replacement treatment for ESRD. This study used ecological theory to examine pre-and post-dialysis education and treatment in a convenience sample of African American ESRD patients. A pilot study of 29 patients and a final sample of 98 patients were used. Patient age, income, education and length of time on dialysis were the independent variables examined. Dependent variables included knowledge, satisfaction, treatment intervention, and quality of life. Oneway analyses of variance (ANOVA) were used to analyze the data. The following research questions were examined: 1) Are African American ESRD patient adequately educated about the disease, its causes, possible complications and range of treatments available? 2) Will African American ESRD patient with higher income and education levels score higher on the knowledge and pre-dialysis education subscale, when compared to patient with lower income and education levels? 3) Is the degree of satisfaction with pre-dialysis information and education positively related to age, level of education and income of African American ESRD patients? 4) Do African American ESRD patients with disparate income and education levels receive different treatment interventions? 5) What are the perceptions of African American dialysis patients regarding their quality of life? When the data were analyzed, the research hypotheses related to questions one and three were not supported (p > .05). While the hypotheses for questions two and four were supported (p < .05). A significant relationship was found between patient satisfaction with pre-dialysis education and treatment and level of education. Other significant relationships were also found when examining the quality of life subscales with income and education.