Document:

<PAGE>
                                                                EXHIBIT 10.19.3

AMGEN                           AMENDMENT NO. 1 RENAL CARE GROUP, INC. AGREEMENT
NO. 200308361
--------------------------------------------------------------------------------

The undersigned hereby agree to amend Agreement No. 200308361 (the "Agreement")
between Amgen USA Inc., located at One Amgen Center Drive, Thousand Oaks,
California 91320 ("Amgen") and Renal Care Group, Inc., located at 2525 West End
Avenue, Suite 600, Nashville, Tennessee 37203 ("RCG") including any prior
amendments thereto, as stated below.

WHEREAS, Amgen and RCG entered into Agreement No. 200308361 effective January 1,
2004;

WHEREAS, the Agreement sets forth the terms and conditions for the purchase of
EPOGEN(R) (Epoetin alfa) and Aranesp(R) (darbepoetin alfa) (collectively,
"Products") by RCG, exclusively for the treatment of dialysis patients; and

WHEREAS, the parties wish to amend this Agreement to modify the term of the
Agreement, offer a Commitment Incentive for the period Amended Date through
December 31, 2004, modify rebate programs for the period January 1, 2005 through
December 31, 2005, and offer new rebates for the period January 1, 2005 through
December 31, 2005.

NOW THEREFORE, in consideration of the premises and of the mutual covenants,
representations and warranties set forth herein, the parties agree as follows:

SECTION 1. AMENDMENT AND RESTATEMENT OF THE GENERAL TERMS AND CONDITIONS - THE
GENERAL TERMS AND CONDITIONS OF THE AGREEMENT SHALL BE AMENDED AND RESTATED IN
THEIR ENTIRETY EFFECTIVE AS FOLLOWS ON DECEMBER 1, 2004 PROVIDED RCG EXECUTES
THIS AMENDED AGREEMENT ON OR BEFORE DECEMBER 1, 2004 ("AMENDED DATE"). IF RCG
EXECUTES THIS AMENDED AGREEMENT AFTER DECEMBER 1, 2004, THE AMENDED DATE SHALL
BE THE DATE ON WHICH THE PARTY LAST TO EXECUTE THIS AMENDED AGREEMENT HAS
EXECUTED THIS AMENDED AGREEMENT.

1.       TERM OF AGREEMENT. The "Term" of this Agreement shall be defined as
         January 1, 2004 ("Commencement Date") through December 31, 2005
         ("Termination Date").

2.       RCG AFFILIATES. RCG must provide Amgen with a complete list of its
         dialysis center affiliates ("Affiliates") on the date this Agreement is
         executed by RCG. Only those Affiliates approved by Amgen and referenced
         in Appendix B hereto will be eligible to participate under this
         Agreement. Modifications to the Affiliates included in Appendix B may
         be made pursuant to the request of RCG's corporate headquarters and are
         subject to approval and acknowledgment by Amgen in writing.
         Notification of proposed changes to the list of Affiliates must be
         provided by RCG to Amgen in writing at least thirty (30) days before
         the effective date of the proposed change. Amgen reserves the right to
         accept, reject, or immediately terminate any Affiliates with regard to
         participation in this Agreement, if Amgen reasonably determines that
         such Affiliate is not properly classified as a freestanding dialysis
         center or home dialysis support facility or if Amgen determines such
         Affiliate is a party to another purchase agreement for EPOGEN(R) or
         Aranesp(R) with Amgen.

3.       AFFILIATE ACQUISITIONS. Should RCG acquire additional Affiliates during
         the Term, and such acquisitions result in an aggregate incremental
         increase in total prior year base sales by more than * Million Dollars
         ($*), then Amgen and RCG agree to meet and in good faith review the
         Agreement in light of the evolving business conditions. For purposes of
         this section, base sales will be derived using the rolling twelve (12)
         month period immediately

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

<PAGE>

                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         preceding the Affiliate acquisition that causes RCG to meet the *
         Million Dollars ($*) limitation, and using the * in effect at *.

4.       OWN USE. RCG hereby certifies that Products purchased hereunder shall
         be for RCG's "own use", for the exclusive treatment of dialysis
         patients.

5.       AUTHORIZED WHOLESALERS. Attached hereto as Appendix C is a complete
         list, as of the date of execution of this Amendment, of the wholesalers
         from which RCG intends to purchase Products pursuant to this Agreement.
         All of the wholesalers so designated by RCG are hereby approved by
         Amgen to participate in this program and are deemed "Authorized
         Wholesalers". Notification of proposed changes to the list of
         Authorized Wholesalers must be provided to Amgen in writing at least
         thirty (30) days before the effective date of the proposed change.
         Amgen reserves the right to accept, reject, or immediately terminate
         any wholesaler with regard to participation in this Agreement. In the
         event Amgen terminates any Authorized Wholesaler from which RCG is
         purchasing Products, Amgen will work with RCG to identify other
         possible Authorized Wholesalers from which RCG may purchase Products.
         In the event that RCG is unable to identify another Authorized
         Wholesaler from which RCG may purchase Products, and subject to receipt
         and approval of an *. RCG agrees to require all Authorized Wholesalers
         to submit product sales information directly to Amgen and to a
         third-party sales reporting organization designated by Amgen.

6.       QUALIFIED PURCHASES. Only Products purchased under this Agreement by
         RCG through *.

7.       COMMITMENT TO PURCHASE. RCG agrees to exclusively purchase Products for
         all of its dialysis use requirements for erythropoietic stimulating
         protein. RCG may purchase another brand of erythropoietic stimulating
         protein for its dialysis use requirements only for the time, and only
         to the extent, that Amgen has notified RCG's corporate headquarters in
         writing that Amgen cannot supply Products within and for the time
         period reasonably required by RCG or for use by any Affiliate that has
         been rejected or excluded by Amgen from participating in this Agreement
         pursuant to any provision of this Agreement.

8.       CONFIDENTIALITY. Both Amgen and RCG agree that this Agreement
         represents and contains confidential information which shall not be
         disclosed to any third party, or otherwise made public, without prior
         written authorization of the other party, except where such disclosure
         is contemplated hereunder or required by law, and then only upon prior
         written notification to the other party.

9.       DISCOUNTS. RCG may qualify for discounts and incentives in accordance
         with the schedules and terms set forth in Appendix A. Discounts in
         arrears will be paid in the form of a check payable to RCG's corporate
         headquarters. Discounts in arrears will be calculated in accordance
         with Amgen's discount calculation policies based on * using the
         prevailing * in effect as of the date of purchase as the calculation
         price, except as otherwise provided hereunder. Upon vesting of all
         earned discounts, Amgen will use its best efforts to make such
         discounts available no later than * after receipt by Amgen of complete
         and machine readable data, in a form acceptable to Amgen, detailing all
         * during the applicable period. Discount amounts, as calculated by
         Amgen, must equal or exceed $* for the applicable period to qualify.
         Subject to Section 12, in the event that Amgen is notified in writing
         that RCG and/or any Affiliates are acquired by another entity or a
         change of control otherwise occurs with respect to RCG or an Affiliate,
         any discounts which may have been earned hereunder shall be paid in the
         form of a check payable to RCG's or the Affiliate's corporate
         headquarters subject to the conditions described herein. If any
         Affiliates are added to or deleted from this Agreement during any of
         the periods used for comparison, for any of the discounts paid in
         arrears contained herein, Amgen reserves the right in its sole and

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -2-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         reasonable discretion to appropriately adjust RCG's discounts for the
         relevant periods, by including or excluding any purchases made by those
         Affiliates during any of those periods.

10.      TREATMENT OF DISCOUNTS. RCG agrees that it will properly disclose and
         account for any discount or other reduction in price earned hereunder,
         in whatever form, (i.e. pricing, discount, or incentive) in a way that
         complies with all applicable federal, state, and local laws and
         regulations, including without limitation, Section 1128B(b) of the
         Social Security Act and its implementing regulations. Section 1128B(b)
         requires that a provider of services will properly disclose and
         appropriately reflect the value of any discount or other reduction in
         price earned in the costs claimed or charges made by the provider under
         a federal health care program, as that term is defined in Section
         1128B(f). RCG also agrees that it will (a) claim the benefit of such
         discount received, in whatever form, in the fiscal year in which such
         discount was earned or the year after, (b) fully and accurately report
         the value of such discount in any cost reports filed under Title XVIII
         or Title XIX of the Social Security Act, or a state health care
         program, and (c) provide, upon request by the U.S. Department of Health
         and Human Services or a state agency or any other federally funded
         state health care program, the information furnished by Amgen
         concerning the amount or value of such discount. RCG's corporate
         headquarters agrees that it will advise all Affiliates, in writing, of
         any discount received by RCG's corporate headquarters hereunder with
         respect to purchases made by such Affiliates and that said Affiliates
         will account for any such discount in accordance with the above stated
         requirements.

11.      DATA COLLECTION. RCG agrees all data to be provided to Amgen pursuant
         to this Agreement shall be in a form that does not disclose the
         identity of any patient or any other patient-identifying information
         such as name, address, telephone number, birth date, all or part of a
         social security number, medical record number or prescription number.
         RCG and Amgen agree to use and accept only those patient identifiers
         compliant with the federal medical privacy standards codified under 45
         C.F.R. parts 160 and 164 pursuant to the Health Insurance Portability
         and Accountability Act ("HIPAA"). RCG acknowledges the data to be
         supplied to Amgen pursuant to this Agreement shall be used to support
         verification of the discounts and incentives referenced herein, as well
         as for Amgen-sponsored research concerning the role of Products in
         improving treatment outcomes and quality of life of dialysis patients.
         RCG shall consistently use a unique alpha-numeric code (which shall not
         be the same as part or all of the patient's social security number) as
         a "case identifier" to track the care rendered to each individual
         patient over time, and such case identifier shall be included in the
         data provided to Amgen. The key or list matching patient identities to
         their unique case identifiers shall not be provided to Amgen personnel.
         In furtherance of Amgen research, RCG may agree from time to time to
         use its key to update the patient care data by linking it with
         information concerning health outcomes, quality of life, and other
         pertinent data that may become available to Amgen from other sources.
         Any such linking of data sources shall not provide the identity of any
         patient to Amgen. Amgen agrees it will maintain data supplied under
         this Agreement in confidence and it will not use such data to identify
         or contact any patient. No reports by Amgen concerning analyses of the
         data or the results of such research shall disclose the identity of any
         patient.

12.      BREACH OF AGREEMENT. If either party materially breaches this
         Agreement, then the other party may terminate this Agreement for breach
         upon thirty (30) days' advance written notice. Upon termination of this
         Agreement by Amgen in accordance with this Section 12, Amgen shall have
         no obligation to continue to offer the terms described herein or pay
         any further discounts to RCG.

13.      GOVERNING LAW. This Agreement shall be governed by the laws of the
         State of California and the parties hereby submit to the jurisdiction
         of the California courts, both state and federal.

14.      WARRANTIES. Each party represents and warrants to the other that this
         Agreement: (a) has been duly authorized, executed, and delivered by it,
         (b) constitutes a valid, legal, and binding agreement enforceable
         against it in accordance with the terms contained herein, and (c) does
         not conflict with or violate any of its other contractual obligations,
         expressed or implied, to which it is a party or by which it may be
         bound. The party executing this

                                      -3-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         Agreement on behalf of RCG specifically warrants and represents to
         Amgen that he is authorized to execute this Agreement on behalf of and
         has the power to bind RCG and the Affiliates to the terms set forth in
         this Agreement. The party executing this Agreement on behalf of Amgen
         specifically warrants and represents to RCG that he is authorized to
         execute this Agreement on behalf of and has the power to bind Amgen to
         the terms set forth in this Agreement.

15.      NOTICES. Any notice or other communication required or permitted
         hereunder shall be in writing and shall be deemed given or made when
         delivered in person or when sent to the other party by first class
         mail, nationally recognized overnight delivery service or other means
         of written communication at the respective party's current address or
         at such other address as the party shall have furnished to the other in
         accordance with this provision.

16.      COMPLIANCE WITH HEALTH CARE PRICING AND PATIENT PRIVACY LEGISLATION AND
         STATUTES; DATA USE AGREEMENT.

         (a) Notwithstanding anything contained herein to the contrary, at any
         time following the enactment of any federal, state, or local law,
         regulation, policy, program memorandum or other interpretation,
         modification or utilization guideline by any governmental payer that in
         any manner reforms, modifies, alters, restricts, or otherwise affects
         the pricing of or reimbursement available for Products, including but
         not limited to a reimbursement or use decision, by Centers for Medicare
         and Medicaid Services ("CMS") or one of its contractors (Carriers or
         Fiscal Intermediaries), Amgen may, in its sole discretion, upon thirty
         (30) days notice, (i) terminate this Agreement, (ii) modify any pricing
         or discount terms contained herein, or (iii) exclude any Affiliates
         from participating in this Agreement. Without limiting the foregoing,
         any change, modification or further clarification to the Medicare
         Modernization Act or any rules or regulations promulgated thereunder,
         or the Hematocrit Measurement Audit Program Memorandum that occurs
         subsequent to the Amended Date would specifically trigger the right to
         the termination or modification referenced herein. Additionally, to
         assure compliance with any existing federal, state or local statute,
         regulation or ordinance, Amgen reserves the right, in its sole
         discretion, to exclude any Affiliates from the pricing and discount
         provisions of this Agreement and/or to reasonably modify any pricing or
         discount terms contained herein. In the event there is a future change
         in Medicare, Medicaid, or other federal or state statute(s) or
         regulation(s) or in the interpretation thereof, which renders any of
         the material terms of this Agreement unlawful or unenforceable, this
         Agreement shall continue only if amended by the parties as a result of
         good faith negotiations as necessary to bring the Agreement into
         compliance with such statute or regulation. In the event Amgen chooses
         to invoke the provisions contained in this Section 16(a), Amgen agrees
         to enter into good faith discussions pertaining to modification of the
         existing agreement or entering into a new agreement, as applicable.

         (b) Notwithstanding anything contained herein to the contrary, at any
         time following the enactment of any federal, state, or local law or
         regulation relating to patient privacy of medical records that in any
         manner reforms, modifies, alters, restricts, or otherwise affects any
         of the data received or to be received in connection with any of the
         incentives contemplated under this Agreement, either party may, in its
         discretion, upon thirty (30) days' notice, seek to modify this
         Agreement with respect to the affected incentive. RCG and Amgen shall
         meet and in good faith seek to mutually agree to modify this Agreement
         to accommodate any such change in law or regulation, with the intent
         to, if possible, retain the essential * structure of the affected
         incentive. If the parties, after reasonable time, are unable to agree
         upon a modification, Amgen shall be entitled to terminate the affected
         incentive upon thirty (30) days' notice or upon such date that the law
         or regulation requires, provided that, if Amgen so terminates an
         incentive, RCG shall be entitled to terminate this Agreement upon
         thirty (30) days notice.

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -4-

<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         (c) Notwithstanding anything contained herein to the contrary, this
         Agreement is effective only as of the date the parties hereto execute a
         mutually agreeable Data Use Agreement pursuant to which RCG may
         disclose a Limited Data Set of patient information to Amgen (as
         specified in the Data Use Agreement and which shall include, at a
         minimum, the data fields to be received by Amgen in connection with
         this Agreement) for purposes of Amgen's Healthcare Operations,
         Research, and Public Health analyses, and RCG's Healthcare Operations.
         Unless otherwise specifically defined in this Agreement, each
         capitalized term used in this Section 16(c) shall have the meaning
         assigned to such term by HIPAA. If RCG terminates the Data Use
         Agreement for any reason, Amgen shall be entitled to terminate this
         Agreement immediately.

17.      FORCE MAJEURE. Neither party will be liable for delays in performance
         or nonperformance of this Agreement or any covenant contained herein if
         such delay or nonperformance is a result of Acts of God, civil or
         military authority, civil disobedience, epidemics, terrorism, war,
         failure of carriers to furnish transportation, strike, lockout or other
         labor disturbances, inability to obtain material or equipment, or any
         other cause of like or different nature beyond the control of such
         party.

18.      RIGHT OF FIRST OFFER. RCG shall promptly notify Amgen in the event it
         receives a competing offer from any third party for the sale of
         products in the same therapeutic class as the Products. Amgen shall
         have the right in such event to have forty-five (45) days to respond to
         RCG with its own pricing terms relating to products.

19.      MISCELLANEOUS. No modification of this Agreement will be effective
         unless mutually agreed upon, made in writing, and executed by a duly
         authorized representative of each party, except as otherwise provided
         hereunder. Neither party may assign this Agreement to a third party
         without the prior written consent of the other party. This Agreement
         may be executed in one or more counterparts, each of which is deemed to
         be an original but all of which taken together constitute one and the
         same agreement.

         (a) Beginning *, RCG's * by all Affiliates listed on Appendix B on the
         Amended Date of this Agreement during any * of this Agreement shall *
         of the * by those same Affiliates for the * . RCG shall not be eligible
         to receive any rebates detailed in Appendix A of this Agreement for any
         * in the aggregate made during any * of this Agreement that * of the *
         by those same Affiliates in the *. Any of RCG's aggregate * of the * by
         those same Affiliates in the * may be approved and eligible to receive
         rebates detailed in Appendix A if *. Such determination must be
         approved by *. For purposes of determining the foregoing, during the
         period *, Products base sales during each applicable time period shall
         be derived using the *.

20.      ENTIRE AGREEMENT. This Agreement constitutes the entire understanding
         between the parties and supersedes all prior written or oral proposals,
         agreements, or commitments pertaining to the subject matter and periods
         of time covered herein.

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -5-

<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

Please retain one fully executed original for your records and return the other
fully executed original to Amgen.

  THE PARTIES EXECUTED THIS AMENDMENT AND RESTATEMENT OF THE AGREEMENT AS OF THE
  DATES SET FORTH BELOW.

AMGEN USA INC.                                RENAL CARE GROUP, INC.

Signature:         /s/ Fred Manak             Signature:     /s/ David M. Dill
              ---------------------------                  ---------------------
Print Name:          Fred Manak               Print Name:      David M. Dill
              ---------------------------                  ---------------------
Print Title:  Dir. U.S. Corporate Pricing     Print Title:      EVP and CFO
              ---------------------------                  ---------------------
Date:                 12/2/04                 Date:              12/1/2004
              ---------------------------                  ---------------------

                                      -6-

<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

SECTION 2.  AMENDMENT AND RESTATEMENT OF APPENDIX A: DISCOUNT PRICING,
SCHEDULE AND TERMS.
--------------------------------------------------------------------------------
APPENDIX A: *

                APPENDIX A: DISCOUNT PRICING, SCHEDULE, AND TERMS

1.       PRICING - ARANESP(R). RCG and Affiliates may purchase Aranesp(R)
         (darbepoetin alfa) through * at a * off of the prevailing *. Amgen
         reserves the right to change the * at any time. Resulting prices do not
         include *.

2.       PRICING - EPOGEN(R). RCG and Affiliates may purchase EPOGEN(R) (Epoetin
         alfa) directly from Amgen or through * at a *, subject to the terms and
         conditions of Section 3 below. Amgen reserves the right to change the *
         at any time. Resulting prices do not include *. All discounts earned in
         arrears hereunder (also known as "rebates"), through the Term of the
         Agreement, shall be calculated based upon*.

3.       REBATE/INCENTIVE QUALIFICATION REQUIREMENTS.

         (a) *: In order for RCG to be eligible to receive any rebates or
         incentives described in Section 4 and Section 7 of this Appendix A, RCG
         must satisfy the following qualification requirement. No more than *
         may have * during each * during the Term of this Agreement *. If this
         criteria is not met during any * of the Term of the Agreement, RCG will
         not qualify for any rebates described in Section 4 and Section 7 of
         this Appendix A during that *. Failure of RCG to qualify under this
         provision during a particular *. The * for each dialysis patient will
         be based upon the average of all * for each patient during each *. RCG
         and Affiliates must provide the following information for each dialysis
         patient to Amgen or to a data collection vendor specified by Amgen, on
         a *, and no later than * after *: all * for each dialysis patient, the
         date of each *, and a consistent, unique, alpha-numeric identifier
         (sufficient consistently to track an individual patient without in any
         way violating the de-identification provisions of HIPAA at 45 CFR
         164.514), along with the name, address and phone number of the
         particular Affiliate at which each patient received treatment. To the
         extent permitted by applicable law, Amgen may utilize the data detailed
         in this provision for any purpose, and reserves the right to audit all
         such data. Under no circumstances should such data include any patient
         identifiable information including, without limitation, name, all or
         part of social security number, address, medical record number, or
         prescription number. The identity of the account submitting the data
         and any association with the data will remain confidential. The * must
         be derived from * taken immediately before dialysis treatment using any
         automated * method *, must be reported to *, and must be submitted
         directly from the clinical laboratory in a format acceptable to Amgen.
         Handwritten reports are not acceptable; only machine readable
         submission of the data will be accepted; and

         (b) *: In order for RCG to be eligible to receive any rebates or
         incentives described in Section 7 of this Appendix A, RCG must satisfy
         the following qualification requirement. RCG's * of EPOGEN(R) and
         Aranesp(R) during * and during * by all Affiliates listed on Appendix B
         on the Commencement Date of this Agreement and those added at the
         beginning of * must equal or exceed * and * respectively *, of the * of
         EPOGEN(R) and Aranesp(R) by those same Affiliates for the time period
         from *, for *, and from * for *. For purposes of calculating the *,
         EPOGEN(R) and Aranesp(R) base sales during each applicable time period
         shall be derived using the * in effect at the Commencement Date. All
         estimated payments for discounts in arrears that contain growth
         requirements will be measured by using a *. If RCG has not satisfied
         the * for any particular *, then *. The determination as to RCG's
         attainment or failure to attain the * shall be based upon the * in
         effect on the Commencement Date.

4.       *. RCG may qualify for the * during each * (as defined in the schedule
         below) as described in this Section 4 of Appendix A.

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -7-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         (a) REQUIREMENT: In order to qualify for the * RCG must meet the *
         contained in Section 3(a) of this Appendix A. If this criteria is not
         met during any * during the period *, RCG will not qualify for *
         described below in this Section 4 during that *.

         (b) CALCULATION: RCG's * will be calculated in accordance with the
         following formula and the * listed below. * will be calculated on a *.

         (c) * . The * schedule is as follows:

         (d) PAYMENT. Estimated payments will be made * using *.

         (e) VESTING. RCG's * will vest at *.

5.       PARTNER INFORMATION PROGRAM *. For the Term of the Agreement RCG shall
         be eligible to receive a * provided certain data elements are
         transmitted to Amgen electronically. The * will be calculated as * of
         EPOGEN(R) attributable to RCG during each *. To qualify for the *, the
         following * must be submitted to Amgen by RCG and all Affiliates * :
         *
         (a) For the period *, the following * shall be added as requirements of
         the *:
         *
         (b) For the period *, the following * shall be removed a
         requirement of the *: *
         Such * must be submitted, on a *, and no later than * after *. If such
         * is received more than * after *, the * of EPOGEN(R) attributable to
         RCG during such * will be excluded from the calculation of the * for
         that * . Notwithstanding the foregoing, if Amgen receives all required
         * from * within the time frame referenced above for any * within a
         given *, the * of EPOGEN(R) attributable to RCG and all Affiliates
         during such *, will be included in the calculation of the * for that *.

6.       *. The purpose of the * is to improve the transmission, quality and
         validation of all data sent from RCG and its Affiliates and received by
         Amgen, such that the processes used by both companies are more
         efficient and timely. For the period * RCG shall be eligible to receive
         a * provided the following requirements below are met. The * will be
         calculated as * of EPOGEN(R) attributable to RCG during each *.

         (a) To qualify for * for the period *, the following requirements must
         be met:

                  i)       RCG must *;
                  ii)      RCG must *.

         (b) To qualify for the * for the period * , the following additional
         requirements must be met:

                  i)       RCG must *;
                  ii)      RCG and Amgen must mutually agree upon *:

                           o        *;
                           o        *;

----------
* Omitted information is the subject of a request for confidential
treatment pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and
has been filed separately with the Securities and Exchange Commission.

                                      -8-

<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

                           o        *;
                           o        *;
                           o        *;
                           o        *;
                           o        *.
                           o        *.

         (c) To qualify for * for the period *, RCG must additionally achieve
         the * goals as set forth in *.

         The * referenced in this Section 6(a)(i) must be submitted, on *, and
         no later than * after *. If such * is received more than * after *, the
         * of EPOGEN(R) attributable to RCG during such * will be excluded from
         the calculation of the * for that *.

         The * will vest * on the * and be paid * in accordance with the terms
         and conditions described above.

7.       *. For the Term of the Agreement, RCG may qualify for the * provided it
         meets the criteria described below in this Section 7. The * is designed
         to improve patient outcomes by encouraging an increase in the number of
         patients managed within both the * set forth in the * which recommends
         a target * and a *.

         (a) Requirements: In order to qualify for the * , RCG must meet the
         Rebate/Incentive Qualification Requirements contained in Section 3 of
         this Appendix A, and RCG and its Affiliates must provide Amgen the
         following data items, on a * , and no later than * after *, in a * . In
         the event * is submitted, instead of *, Amgen will convert such * to *
         by *. Amgen will convert all * for each patient by RCG and its
         Affiliates, AND all the * for each patient by RCG and its Affiliates
         into the * for each patient by RCG and its Affiliates, AND the * for
         each patient by RCG and its Affiliates for each of the * (as defined in
         the schedule immediately below). RCG hereby certifies that the *
         submitted for each eligible Affiliate includes the required results
         from all dialysis patients of such Affiliate, and does not include
         results from non-patients. RCG also represents and warrants that it (i)
         has no reason to believe that the submitted * is incorrect, and (ii) is
         authorized to make this certification on behalf of all eligible
         Affiliates submitting *.

                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------
                                             *
                ----------------------------------------------------------------

         (b) Calculation: Assuming RCG and Affiliates have fulfilled all
         requirements as described in Section 7(a) above, to qualify for the *,
         RCG must achieve an increase in the *, as that term is defined below,
         from the *, as that term is defined below, during each *, and such
         increase shall be defined as *.

         For purposes of this Section 7, * shall mean * for each patient by RCG
         and its Affiliates AND the * for each patient by RCG and its Affiliates
         during the period *; and * shall mean * for each patient by RCG and its
         Affiliates AND * for each patient by RCG and its Affiliates for each of
         the above referenced *.

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -9-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

         Using the * described above, the * will be calculated as the *, as
         shown below:

                                            *
                                            *
            --------------------------------------------------------------------
                                            *

         Using the * described above, which shall be calculated on a *, the *
         for each * will be calculated as the *, as shown below:

                                            *

                                            *
            --------------------------------------------------------------------
                                            *

         The * shall then be calculated by *, as shown below:

                                            *

         The * will be calculated on a * in accordance with *. Following
         determination of the *, Amgen shall then calculate RCG's * in
         accordance with the following formula and the * listed below:

                                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------

                                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------

                                            *
                                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -10-

<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------
            *                          *                            *
--------------------------------------------------------------------------------

         (c) Payment: The * will be calculated and paid to RCG on a *. Payment
         is contingent upon *. Such * must be submitted, on a *, and no later
         than * after *. If such * is received more than * after * within a
         given *, the * of EPOGEN(R) attributable to RCG during such * will be
         excluded from the calculation of the *. Notwithstanding the foregoing,
         if Amgen receives all required * from * within the time frame
         referenced above for any * within a *, the * of EPOGEN(R) attributable
         to RCG and all Affiliates during such *, will be included in the
         calculation of the *. However, if Amgen determines that any Affiliate
         is consistently not submitting the required *

         The * will vest * on the * and * respectively, and be paid * in
         accordance with the terms and conditions described above.

8.       * . For the period *, RCG may qualify for * as outlined below.

         (a) Calculation: *

         (b) Payment and Vesting: The * will vest on the * and will be paid
         within * after *.

----------
* Omitted information is the subject of a request for confidential treatment
pursuant to Rule 24b-2 under the Securities Exchange Act of 1934 and has been
filed separately with the Securities and Exchange Commission.

                                      -11-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

                       APPENDIX B: LIST OF RCG AFFILIATES

(To be provided by RCG)

                                      -12-
<PAGE>
                             AMENDMENT NO. 1 AGREEMENT NO. 200308361 (CONTINUED)
--------------------------------------------------------------------------------

                         APPENDIX C: LIST OF WHOLESALERS

TO ENSURE RCG RECEIVES THE APPROPRIATE DISCOUNT, IT IS IMPORTANT AMGEN RECEIVES
RCG'S CURRENT LIST OF AUTHORIZED WHOLESALERS. THE FOLLOWING LIST REPRESENTS THE
WHOLESALERS AMGEN CURRENTLY HAS ASSOCIATED WITH RCG'S CONTRACT. PLEASE UPDATE
THE LIST BY ADDING OR DELETING WHOLESALERS AS NECESSARY.

                                      -13-<PAGE>

                                                                   EXHIBIT 10.49

                              EMPLOYMENT AGREEMENT

      THIS AGREEMENT is made and entered into effective as of the 3rd day of
February 2005, by and between RENAL CARE GROUP, INC., a Delaware corporation
(the "Company"), and DAVID MALONEY (hereinafter "Employee").

                                   WITNESSETH:

      WHEREAS, Employee is currently Senior Vice President, Chief Information
Officer, and the Company desires to employ and retain Employee to act as its
Executive Vice President and Chief Information Officer; and

      WHEREAS, Employee desires to remain an employee of the Company on the
terms and conditions contained in this Agreement; and

      NOW, THEREFORE, in consideration of the compensation payable to Employee
by the Company pursuant to this Agreement, and the mutual promises, covenants,
representations and warranties contained herein, the receipt and sufficiency of
which are hereby acknowledged, the parties hereto do agree as follows:

      1.    Employment.

            The Company employs Employee and Employee accepts employment with
the Company under the terms of this Agreement effective as of February 3, 2005
(the "Effective Date").

      2.    Term.

            The term of this Agreement shall begin on the Effective Date and
shall continue for an initial term beginning on the Effective Date and ending on
December 31, 2007 (the "Initial Period"), subject to earlier termination by
Employee or the Company as hereinafter provided. Unless one party gives the
other notice of non-renewal not less than 60 days prior to the expiration of the
Initial Period or an additional term, this Agreement shall renew for additional
terms of 12 months each on the same terms and conditions (subject to mutually
agreeable modifications, if any), provided that this Agreement may be terminated
earlier as contemplated below,.

      3.    Compensation and Benefits.

            (a) Base Compensation. The Company shall pay Employee a base salary
at an annual rate of $300,000 from the Effective Date through March 31, 2005
(the "Base Compensation"). Such Base Compensation may be adjusted as provided
herein. The Base Compensation is payable according to the pay periods of the
Company as may be in effect from time to time. Such payments will be prorated
for periods less than a full pay period. The Base Compensation will be subject
to withholding for federal, state and local payroll and all other taxes or
withholdings applicable to Employee. Any increases of the Base Compensation will
be at the discretion of the Company, provided that the Company may not decrease
the then current Base Compensation without the consent of Employee. The Base
Compensation and target percentage for the Annual Bonus (as defined below) will
be reviewed annually by the Compensation Committee of the Company.

<PAGE>

            (b) Benefits. During the term of this Agreement, Employee shall also
be entitled to participate in the insurance and other fringe benefits made
available generally to senior management employees of the Company, as such
benefits may be determined from time to time by the Company. Employee may take
vacations at times and for periods that are approved from time to time by the
Company's President and Chief Executive Officer in his reasonable discretion,
Employee not accruing any vacation time for purposes of compensation upon
termination of employment. The Company and Employee acknowledge and agree that
vacation time of at least four weeks per calendar year is expected, but that
such amount may be more or less in any specific. In addition, during the term of
this Agreement, the Company will provide to Employee term life insurance
coverage of $1,000,000 on Employee's life payable to one or more beneficiaries
designated by Employee from time to time.

            (c) Annual Bonuses. In addition to the Base Compensation, Employee
will be entitled to an annual bonus (the "Annual Bonus"), with a target amount
equal to 75% of the Base Compensation for such year. The actual amount of the
Annual Bonus paid will be determined based on the Company's and Employee's
achievement of performance goals reasonably established by the Compensation
Committee of the Company and, in the case of performance goals established
specifically for Employee, agreed to by Employee. The Company agrees that the
Company-related performance goals for Employee shall be substantially similar to
those established for other members of senior management.

            (d) Expenses. The Company shall reimburse Employee for any and all
expenses reasonably incurred by Employee incident to the performance of the
duties imposed upon Employee hereunder.

      4.    Duties, Extent of Services.

            Employee is employed as Executive Vice President and Chief
Information Officer of the Company and shall be generally responsible for
overseeing the information services and technology needs for the Company's
business. As such, Employee will perform such duties and responsibilities as are
typically incident thereto and will perform in a faithful and competent manner
such additional duties as may be reasonably assigned to Employee from time to
time by Chief Executive Officer and President of the Company. Throughout the
term of this Agreement, Employee will report to the Chief Executive Officer and
President of the Company. Employee's duties for the Company will be performed on
a full-time basis at the Company's corporate offices in Nashville, Tennessee.
Employee may be required, from time to time, to perform his duties temporarily
hereunder at such other place or places as the Company shall reasonably require,
provided that such period does not exceed 30 consecutive days without Employee's
consent and that during any such period Employee is able to return to Nashville,
Tennessee at the Company's expense for weekends.

            Employee will devote all of Employee's business time, attention,
knowledge, and skill solely to the business and interest of the Company, and the
Company will be entitled to all the benefits, profits, and other issues arising
from, or incident to, all work, services, and advice of Employee.

      5.    Termination.

            This Agreement may be terminated by the parties in the manners
specified below:

                                      -2-
<PAGE>

            (a) Termination without Cause. Either the Company or Employee may
terminate Employee's employment under this Agreement at any time for any reason
or no reason upon 30 days' prior written notice to the other party.

            (b) Termination for Cause. The Company may terminate this Agreement
on written notice at any time for "Cause". For purposes of this Agreement,
"Cause" means: (i) Employee is convicted of, pleads guilty to, or confesses to a
felony or any crime involving any act of dishonesty, fraud, misappropriation,
embezzlement or moral turpitude, in which event the Company may terminate this
Agreement immediately, (ii) the misconduct or gross negligence by Employee in
connection with the performance of Employee's duties hereunder, (iii) the
engaging by Employee in any fraudulent, disloyal or unprofessional conduct which
results in an injury to the Company, its affiliates or any of its or their
centers, monetarily or otherwise, (iv) Employee breaches any provision of
Section 6 of this Agreement, or (v) the material failure by Employee otherwise
substantially to perform his duties with the Company (other than any such
failure resulting from the disability of Employee under Section 5(d)(i)) or the
breach of any provision of this Agreement other than Section 6. If the Company
terminates this Agreement for Cause pursuant to the provisions of (ii), (iii),
(iv) or (v) of this subsection (b), then the Company will give Employee written
notice prior to such termination detailing the specific acts, actions, failures,
or events upon which the forecast termination is based. Employee will have 15
days after such written notice to cease such actions or otherwise correct any
such failure or breach. If Employee does not cease such action or otherwise
correct such failure or breach within such 15-day period, or having once
received such written notice and ceased such actions or corrected such failure
or breach, Employee at any time thereafter again so acts, fails or breaches, the
Company may terminate this Agreement immediately.

            (c) Termination for Good Reason. Employee may terminate this
Agreement on written notice at any time for "Good Reason". For purposes of this
Agreement, "Good Reason" means: (i) without the express written consent of
Employee, a material diminution of his position, duties, responsibilities and
status with the Company as in effect as of the Effective Date, a change in
Employee's reporting responsibilities, a material reduction of Employee's titles
or offices as in effect on the date of this Agreement, or the removal of
Employee from, or failure to re-elect Employee to, any position referred to in
Section 4 of this Agreement, except in connection with the termination of this
Agreement for Cause; (ii) any reduction of the Base Compensation; (iii) the
requirement that Employee relocate outside of the Nashville, Tennessee
metropolitan area; (iv) the material breach by the Company of any material
provision of this Agreement, which breach continues uncorrected and uncured for
15 days after Employee gives notice of such breach to the Company; or (v) the
termination of this Agreement by written notice from Employee to the Company
during the 30-day period immediately following the first anniversary of a Change
in Control (as defined below).

            (d) Involuntary Termination. The employment of Employee hereunder
will be automatically terminated by the death or disability of Employee as
outlined below.

                  (i) Disability. The Company may terminate this Agreement at
such time as Employee shall have been Disabled (as defined below) for a
continuous period of six months during any continuous 12-month period. For
purposes of this Section 5(d)(i), the term "Disabled" means Employee's inability
to perform the essential functions of his duties, with or without reasonable
accommodation. During Employee's six-month period of Disability, the Company
will continue to pay Employee's Base Compensation (less regular withholdings for
payroll or other taxes and other required or proper items, and less proceeds
from all disability insurance policies or plans provided or made available by
the Company). In the event of a termination of Employee on account of
Disability, the Company will pay Employee's Base Compensation for a period of
six months following the effective date of termination (less regular
withholdings for payroll or other taxes and other required or proper times, and
less proceeds

                                      -3-
<PAGE>

from all disability insurance policies or plans provided or made available by
the Company). In addition, any provisions in the relevant stock option
agreements notwithstanding, all outstanding stock options granted to Employee by
the Company will vest immediately upon termination pursuant to this Section
5(d)(i).

                  (ii) Death. If Employee dies during the term of this
Agreement, this Agreement shall terminate and Employee's estate shall receive
the remainder of the Base Compensation set forth in Section 3(a) hereof accrued
to the last day of the month in which death occurs. In addition, any provisions
in the relevant stock option agreements notwithstanding, all outstanding stock
options granted to Employee by the Company will vest immediately upon
termination pursuant to this Section 5(d)(i).

            (e) Post-Termination Compensation. Except as provided in Section
5(d) above, upon termination of this Agreement, the Company shall be relieved of
all of its obligations hereunder notwithstanding any period of time remaining
under the initial or any renewal term, subject to the following:

                  (i) Termination without Cause or with Good Reason. Except as
provided in Section 5(e)(iv) below, if the Company terminates Employee's
employment hereunder without Cause under Section 5(a) above or if Employee
terminates Employee's employment hereunder with Good Reason under Section 5(c)
above or if this Agreement expires as a result of the Company's giving notice of
non-renewal as contemplated by Section 2 above, then the Company will pay to
Employee, after the effective date of such termination, as Employee's sole and
exclusive remedy, (A) an amount equal to (I) the Base Compensation (as then in
effect) plus an amount of Annual Bonus equal to the target percentage of Base
Compensation (as then in effect) multiplied by (II) two, and (B) any unpaid
bonus payable for the most recently completed calendar year. The Company will
make any payment due under this clause (iv) in a single lump-sum payment not
later than 30 days after termination. If the Company terminates Employee's
employment without Cause or if Employee terminates Employee's employment
hereunder with good reason or if this Agreement expires as a result of the
Company's giving notice of non-renewal, Employee shall be under no duty to seek
or accept other employment; but if he shall do so, any compensation he shall
receive from such other employment will not diminish the Company's obligation to
make payments required to the Employee hereunder.

                  (ii) Termination without Good Reason. If Employee terminates
his employment under Section 5(a) above, then the Company's obligation to pay
Employee's Base Compensation will terminate as of the date of termination.

                  (iii) Termination for Cause. If the Company terminates
Employee's employment with Cause under Section 5(b) above, then the Company will
pay Employee, after the effective date of such termination, the Base
Compensation (as then in effect) for a period of one month after the termination
date.

                  (iv) Termination following Change in Control. If, within
twelve (12) months following a Change in Control, either (A) the Company
terminates the employment of Employee hereunder without Cause under Section 5(a)
above or (B) Employee terminates his employment for Good Reason under Section
5(c) above (except for a termination under clause (v) of Section 5(c)), then, in
lieu of any other compensation that may be specified in this Agreement, the
Company will pay Employee an amount equal to (I) the Base Compensation (as then
in effect) plus an amount of Annual Bonus equal to the target percentage of Base
Compensation (as then in effect) multiplied by (III) three. If Employee
terminates his employment for Good Reason under clause (v) of Section 5(c)
above, then, in lieu of any

                                      -4-
<PAGE>

other compensation that may be specified herein, the Company will pay Employee
an amount equal to (i) the Base Compensation (as then in effect) plus an amount
of Annual Bonus equal to the target percentage of Base Compensation (as then in
effect) multiplied by (II) two. The Company will make any payment due under this
clause (iv) in a single lump-sum payment not later than 30 days after
termination. If any payment obligation under this Section 5(e) arises, no
compensation received from other employment (or otherwise) will reduce the
Company's obligation to make the payment(s) described in this paragraph.

            (f) Change in Control. "Change in Control" means a change in control
of the Company of a nature that would be required to be reported (assuming such
event has not been "previously reported") in response to Item 5.01(a) of a
Current Report on Form 8-K pursuant to Section 13 or 15(d) of the Exchange Act
of 1934 (the "Exchange Act"); provided that, without limitation, a Change in
Control shall also be deemed to have occurred at such time as:

                  (i) Any "person" within the meaning of Section 14(d) of the
Exchange Act, other than the Company; a subsidiary, or any employee benefit
plan(s) sponsored by the Company or any Subsidiary, is or has become the
"beneficial owner," as defined in rule l3d-3 under the Exchange Act, directly or
indirectly, of 25% or more of the combined voting power of the outstanding
securities of the Company ordinarily having the right to vote at the election of
directors, or

                  (ii) Individuals who constitute the Board immediately prior to
any meeting of stockholders (the "Incumbent Board") have ceased for any reason
to constitute at least a majority thereof, provided that any person becoming a
director whose election, or nomination for election by the Company's
stockholders, was approved by a vote of at least three-quarters (3/4) of the
directors comprising the Incumbent Board (either by a specific vote or by
approval of the proxy statement of the Company in which such person is named as
a nominee for director without objection to such nomination) will be, for
purposes of this Agreement, considered as though such person were a member of
the Incumbent Board; or

                  (iii) Upon approval by the Company's stockholders of a
reorganization, merger, share exchange or consolidation, other than a
reorganization, merger, share exchange or consolidation with respect to which
those persons who were the beneficial owners, immediately prior to such
reorganization, merger, share exchange or consolidation, of outstanding
securities of the Company ordinarily having the right to vote in the election of
directors own, immediately after such transaction, more than 75% of the
outstanding securities of the resulting corporation ordinarily having the right
to vote in the election of directors; or

                  (iv) Upon approval by the Company's stockholders of a complete
liquidation and dissolution of the Company or the sale or other disposition of
all or substantially all of the assets of the Company other than to a
Subsidiary.

      6.    Nondisclosure, Confidentiality; Competition.

            (a) Subject to Section 6(f) below, Employee agrees that, during the
term of this Agreement and of Employee's employment by the Company, and for a
period 12 months after the termination of Employee's employment with the
Company, Employee will not in any manner, directly or indirectly, by himself or
in conjunction with any other person, (i) conduct any of the activities or
perform any of the responsibilities or duties that Employee provided the Company
during his employment by the Company for any business entity that is competitive
with the business of the Company or its affiliates or (ii) establish or own any
financial, beneficial or other interest in (other than an interest consisting of
less

                                      -5-
<PAGE>

than one percent (1%) of a class of publicly traded security), make any loan to
or for the benefit of, or render any managerial, marketing or other business
advice, to any entity that is then conducting activities that are competitive
with those of the business of the Company or its affiliates, in either case
within a geographic territory defined as a 75-mile radius of any renal dialysis
center, unit or facility owned or operated by the Company or an affiliate of the
Company. For purposes of this Section, the "business of the Company or its
affiliates" means owning or operating a renal dialysis center, unit or facility.

            (b) Employee further agrees that, for a period of three years after
the termination of Employee's employment with the Company, Employee will keep
confidential and not directly divulge, or allow through a lack of reasonable
care to be divulged to anyone, or use or otherwise appropriate for Employee's
own benefit or for the benefit of others, any knowledge or information of a
confidential nature with respect to the Company's and its affiliates' current
business, the Company itself, or any of its affiliates, including all trade
secrets, pricing information, marketing information or technical information
(hereinafter referred to as the "Confidential Data"), except for (i) a
disclosure that is required by law; or (ii) information that has been made
generally available to the public by the act of one who has the right to
disclose such information; or (iii) information that has become part of the
public domain through no fault of Employee. Employee acknowledges and agrees
that the prohibitions against disclosure of Confidential Data recited herein are
in addition to, and not in lieu of, any rights or remedies the Company may have
available pursuant to the laws of any jurisdiction or at common law to prevent
the disclosure of confidential information, and the enforcement by the Company
of its rights and remedies pursuant hereto shall not be construed as a waiver of
any other rights or available remedies which the Company may possess in law or
equity. Employee acknowledges that the Company has taken reasonable and
appropriate steps to ensure the confidentiality and non-disclosure of all such
Confidential Data. For purposes of this Section the Company's and its
affiliates' "current business" means owning or operating a renal dialysis
center, unit or facility.

            (c) Subject to Section 6(f) below, Employee further agrees that, for
a period of three years after the termination of Employee's employment with the
Company, Employee will not, for his own benefit or the benefit of others,
solicit any person or entity that has or has had, or disrupt or attempt to
disrupt, any relationship, contractual or otherwise, with the Company or an
affiliate of the Company (including any patient, payor, physician, provider,
managed care organization or supplier) at any time during Employee's employment
with the Company, for the purpose of assisting, or creating such a relationship
for, any business entity that is competitive with the Company or an affiliate of
the Company. For purposes of this Section, a business entity is competitive with
the Company or an affiliate of the Company if it provides or offers any renal
dialysis service that is provided by the Company or an affiliate of the Company.

            (d) Subject to Section 6(f) below, Employee further agrees that, for
a period of three years after the termination of Employee's employment with the
Company, Employee shall not induce, nor attempt to induce, any employee of the
Company, or any of its affiliates, to terminate such employee's association with
the Company or any of its affiliates.

            (e) These post-employment covenants are considered by the parties
hereto to be fair, reasonable and integral for the protection of the Company.
The parties mutually agree that if a violation of any of these covenants occurs,
such violation or any threatened violation will cause irreparable injury to the
Company and the remedy at law for any such violation or threatened violation
will be inadequate. The parties acknowledge that these covenants will survive,
and remain in effect and enforceable after, termination of this Agreement.

                                      -6-
<PAGE>

            (f) The Company agrees that the forgoing covenants in subsections
(a), (c) and (d) of this Section 6 shall be null and void as to any period
following termination of Employee's employment if such termination occurs within
13 months after a Change in Control through either (A) a termination by the
Company without Cause under Section 5(a) above or (B) a resignation by Employee
for any reason.

            (g) Employee agrees to indemnify and hold harmless the Company from
and against any and all claims, causes of action, damages and/or any other
losses suffered or incurred by the Company as a result of any breach or
purported breach by Employee of any agreement applicable to Employee which
existed prior to the time of the entering into of this Agreement. The
obligations of Employee to indemnify and hold the Company harmless include any
and all costs of defense of any such claim or threatened claim, including
reasonable attorneys' fees.

      7.    Certain Additional Payments by the Company.

            (a) Anything in this Agreement to the contrary notwithstanding and
except as set forth below, if any payment or distribution by the Company to or
for the benefit of Employee (whether paid or payable or distributed or
distributable pursuant to the terms of this Agreement or otherwise, but
determined without regard to any additional payments required under this Section
7) (a "Payment") would be subject to the excise tax imposed by Section 4999 of
the Code or any interest or penalties are incurred by Employee with respect to
such excise tax (such excise tax, together with any such interest and penalties,
are hereinafter collectively referred to as the "Excise Tax"), then the Company
will make an additional payment (a "Gross-Up Payment") to Employee in an amount
such that after payment by Employee of all taxes (including any interest or
penalties imposed with respect to such taxes), including, without limitation,
any income taxes (and any interest and penalties imposed with respect thereto)
and Excise Tax imposed upon the Gross-Up Payment, Employee retains an amount of
the Gross-Up Payment equal to the Excise Tax imposed upon the Payments.

            (b) Subject to the provisions of Section 7(c), all determinations
required to be made under this Section 7, including whether and when a Gross-Up
Payment is required and the amount of such Gross-Up Payment and the assumptions
to be utilized in arriving at such determination, will be made by Ernst & Young
LLP or such other certified public accounting firm as may be designated by
Employee (the "Accounting Firm") which shall provide detailed supporting
calculations both to the Company and Employee within 15 business days of the
receipt of notice from Employee that there has been a Payment, or such earlier
time as is requested by the Company. In the event that the Accounting Firm is
serving as accountant or auditor for the individual, entity or group effecting
the Change in Control, Employee shall appoint another nationally recognized
accounting firm to make the determinations required hereunder (which accounting
firm shall then be referred to as the Accounting Firm hereunder). All fees and
expenses of the Accounting Firm shall be borne solely by the Company. Any
Gross-Up Payment, as determined pursuant to this Section 7, shall be paid by the
Company to Employee within five business days of the receipt of the Accounting
Firm's determination. Any determination by the Accounting Firm shall be binding
upon the Company and Employee. It is possible (due to the uncertainty in the
application of Section 4999 of the Code at the time of the initial determination
by the Accounting Firm hereunder) that Gross-Up Payments will not have been made
by the Company which it is ultimately determined should have been made
("Underpayment"), consistent with the calculations required to be made
hereunder. Consequently, if the Company exhausts its remedies pursuant to
Section 7(c) and Employee thereafter is required to make a payment of any Excise
Tax, the Accounting Firm shall determine the amount of the Underpayment that has
occurred and the Company will promptly pay any such Underpayment to or for the
benefit of Employee.

                                      -7-
<PAGE>

            (c) Employee will notify the Company in writing of any claim by the
Internal Revenue Service that, if successful, would require the payment by the
Company of the Gross-Up Payment. Such notification shall be given as soon as
practicable but no later than 10 business days after Employee is informed in
writing of such claim, and such notification will apprise the Company of the
nature of such claim and the date on which such claim is requested to be paid.
Employee will not pay such claim prior to the expiration of the 30-day period
following the date on which Employee gives such notice to the Company (or such
shorter period ending on the date that any payment of taxes with respect to such
claim is due). If the Company notifies Employee in writing prior to the
expiration of such period that it desires to contest such claim, Employee will:

                  (i) Give the Company any information reasonably requested by
the Company relating to such claim,

                  (ii) Take such action in connection with contesting such claim
as the Company reasonably requests in writing from time to time, including,
without limitation, accepting legal representation with respect to such claim by
an attorney reasonably selected by the Company,

                  (iii) Cooperate with the Company in good faith in order
effectively to contest such claim, and

                  (iv) Permit the Company to participate in any proceedings
relating to such claim;

provided, however, that the Company will bear and pay directly all costs and
expenses (including additional interest and penalties) incurred in connection
with such contest and will indemnify and hold Employee harmless, on an after-tax
basis, for any Excise Tax or income tax (including interest and penalties with
respect thereto) imposed as a result of such representation and payment of costs
and expenses. Without limitation of the foregoing provisions of this Section
7(c), the Company will control all proceedings taken in connection with such
contest and, at its sole option, may pursue or forgo any and all administrative
appeals, proceedings, hearings and conferences with the taxing authority in
respect of such claim and may, at its sole option, either direct Employee to pay
the tax claimed and sue for a refund or contest the claim in any permissible
manner, and Employee agrees to prosecute such contest to a determination before
any administrative tribunal, in a court of initial jurisdiction and in one or
more appellate courts, as the Company may determine; provided, however, that if
the Company directs Employee to pay such claim and sue for a refund, the Company
will advance the amount of such payment to Employee, on an interest-free basis
and will indemnify and hold Employee harmless, on an after-tax basis, from any
Excise Tax or income tax (including interest or penalties with respect thereto)
imposed with respect to such advance or with respect to any imputed income with
respect to such advance; provided, further, that any extension of the statute of
limitations relating to payment of taxes for the taxable year of Employee with
respect to which such contested amount is claimed to be due is limited solely to
such contested amount. Furthermore, the Company's control of the contest will be
limited to issues with respect to which a Gross-Up Payment would be payable
hereunder and Employee will be entitled to settle or contest, as the case may
be, any other issue raised by the Internal Revenue Service or any other taxing
authority.

            (d) If, after the receipt by Employee of an amount advanced by the
Company pursuant to Section 7(c), Employee becomes entitled to receive any
refund with respect to such claim, Employee will (subject to the Company's
complying with the requirements of Section 7(c)) promptly pay to the Company the
amount of such refund (together with any interest paid or credited thereon after
taxes applicable thereto). If, after the receipt by Employee of an amount
advanced by the Company pursuant to

                                      -8-
<PAGE>

Section 7(c), a determination is made that Employee is not entitled to any
refund with respect to such claim and the Company does not notify Employee in
writing of its intent to contest such denial of refund prior to the expiration
of thirty (30) days after such determination, then such advance will be forgiven
and Employee shall not be required to repay and the amount of such advance will
offset, to the extent thereof, the amount of Gross-Up Payment required to be
paid.

      8.    Severability.

            The parties hereto hereby expressly agree and contract that it is
not the intention of either party to violate any public policy, or any statutory
or common law, and that if any paragraph, sentence, clause or combination of the
same of this Agreement will be in violation of the laws of any state where
applicable, such paragraph, sentence, clause or the combination of the same will
be void in the jurisdictions where it is unlawful, and the remainder thereof
shall remain binding on the parties hereto. It is the intention of the parties
to make the covenants of this Agreement binding only to the extent that they may
be lawfully done under existing applicable laws. In the event that any part of
any term or covenant of this Agreement is determined by a court of law or equity
to be overly broad or otherwise unenforceable, the parties hereto agree that
such court shall be empowered to substitute, and it is the intent of the parties
hereto that such court substitute, a reasonably judicially enforceable term or
limitation in the place of such unenforceable term or covenant, and that as so
modified this Agreement will be fully enforceable.

      9.    Entire Agreement; Modification.

            This Agreement constitutes the entire agreement between the parties
and supersedes any and all prior understandings or agreements. Any changes or
additions to this Agreement must be in writing and signed by both parties. If
there is any conflict between the terms of this Agreement and any stock option
agreement or other agreement between Employee and the Company (including any
agreement entered into after the date of this Agreement), then this Agreement
will control unless there is specific reference to superseding this Agreement in
such other agreement or in this Agreement.

      10.   Assignment.

            (a) The rights and benefits of Employee under this Agreement, other
than accrued and unpaid amounts due under Section 3(a) hereof, are personal to
Employee and are not assignable.

            (b) This Agreement may not be assigned by the Company except to an
affiliate of the Company, provided that such affiliate assumes the Company's
obligations under this Agreement; provided, further, that if the Company merges
or effects a consolidation or share exchange with or into, or sells or otherwise
transfers substantially all its assets to, another business entity, the Company
may assign its rights hereunder to that business entity without the consent of
the Employee provided that it causes such business entity to assume the
Company's obligations under this Agreement and provided, further, that the
provisions of Section 5 remain in full force and effect following such
assignment.

      11.   Notice.

            Unless otherwise specifically provided, references to notice periods
of a certain number of "days" contained in this Agreement are references to
calendar days. Any notice provided for in this Agreement shall be delivered to
Employee at the most recent address of Employee listed in the Company's then
current employment records. Notice to the Company shall be delivered to the
following

                                      -9-
<PAGE>

address: c/o Renal Care Group, Inc., 2525 West End Avenue, Suite 600, Nashville,
Tennessee 37203, Attention: Chief Executive Officer and General Counsel.

      12.   Waiver.

            The waiver by any party to this Agreement of a breach of any of the
provisions contained herein will not operate or be construed as a waiver of any
subsequent breach.

      13.   Disputes and Governing Law.

            The Company and Employee agree that any dispute arising in
connection with, or relating to, this Agreement or the termination of this
Agreement, to the maximum extent allowed by applicable law, will be subject to
resolution through informal methods and, failing such efforts, through
arbitration. Either party may notify the other party of the existence of a
dispute by written notice to the address indicated above in Section 11. The
parties will thereafter attempt in good faith to resolve their differences
within 30 days after the receipt of such notice. If the dispute cannot be
resolved within such 30-day period, either party may file a written demand for
arbitration with the other party. The arbitration shall proceed in accordance
with the terms of the Federal Arbitration Act and the Commercial Arbitration
Rules of the American Arbitration Association. A single arbitrator shall be
appointed through the American Arbitration Association's procedures to resolve
the dispute.

            The parties agree that in the event arbitration is necessary, the
laws of the State of Tennessee and any applicable federal law shall apply. The
place of the arbitration shall be Nashville, Tennessee.

            The award of the arbitrator shall be binding and conclusive upon the
parties. Either party shall have the right to have the award made the judgment
of a court of competent jurisdiction in the State of Tennessee.

            In the event of a dispute arising under this Agreement, the
prevailing party shall be entitled to all reasonable attorneys' fees incurred in
connection with such dispute. The Company and Employee are parties to an
Indemnification Agreement effective as of August 13, 2002, which the parties
specifically ratify and confirm by this reference.

            [the remainder of this page is intentionally left blank]

                                      -10-
<PAGE>

            IN WITNESS WHEREOF, the Company and Employee have executed this
Agreement on the day and year first above written.

                                                   COMPANY:
                                                   RENAL CARE GROUP, INC.

                                                   By: /s/ Gary A. Brukardt
                                                       -------------------------
                                                   Title: President

                                                   EMPLOYEE:

                                                   /s/ David Maloney
                                                   -----------------------------
                                                   DAVID MALONEY

                                      -11-

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00079-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00079-of-00352.parquet"}]]