As medical advances have increased the expected longevity of ESRD patients, the familial elements of adjustment to this illness and its treatment regimen have become particularly important. Over the past dozen years, a body of literature has accumulated on the psychosocial adjustment of ESRD patients and their partners. In general, it has shown that each spouse's individual adjustment may be strongly influenced by the other's reactions to the illness. However, a good integration of an interpersonal framework has been lacking in most of these studies. This article reviews the area and offers methodological and theoretical suggestions for future investigations.