Inclusion Criteria:  African American Receiving hemodialysis treatments Been on hemodialysis for more than 30 days 18 years of age and older Within a 3-month look back at the time of screening, patients who have missed at least one dialysis session or shortened at least one dialysis session by 15 minutes.  Exclusion Criteria:  Not self-identified as African American Impaired with mental status or severe illness Non-English speaking No documented evidence of dialysis treatment non-adherence Missed or shortened treatments due to hospitalizations or excused travel Terminal condition Living in a nursing home/rehab Planned transplant within the next 3 months Planned conversion to peritoneal dialysis within the next 3 months