Objectives: Hope is important in determining positive outcomes in a range of chronic illnesses. This study examined the role of hope in adjustment to end-stage renal failure (ESRF) and consequent dialysis. Design: A cross-sectional design examined the ability of hope to predict adjustment to ESRF over and above other relevant variables. Methods: Individuals receiving dialysis at 4 units in the North-West UK were invited to take part in the study. 103 questionnaire packs were included in the analysis. Multiple regression equations determined whether hope was able to predict significant variance in adjustment over and above that accounted for by other factors (demographic and illness-related factors, perceived control, and social support). Measures of anxiety, depression, and quality of life constituted a multidimensional measure of adjustment to ESRF. Results: Each of the regression models was significant. Hope emerged as an independent significant predictor in five of the multiple regressions: anxiety; depression; effects and symptoms of kidney disease; and mental health quality of life. Age also emerged as an important predictor of outcome. Conclusions: It appears that hope is a significant predictor of adjustment to ESRF. Clinical implications of this research are discussed, along with suggestions for future research.