Document:

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                                                                   EXHIBIT 10.45

                              EMPLOYMENT AGREEMENT

         THIS AGREEMENT is made and entered into effective as of the 30th day of
November 2003, by and between RENAL CARE GROUP, INC., a Delaware corporation
(the "Company"), and TIMOTHY P. MARTIN (hereinafter "Employee").

                                   WITNESSETH:

         WHEREAS, Employee is currently Group Senior Vice President, East Group,
and the Company desires to employ and retain Employee to act as its Executive
Vice President of Operations; 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 November ___,
2003 (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, 2006 (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, subject to earlier termination as
hereinafter provided, on the same terms and conditions (subject to mutually
agreeable modifications, if any).

         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, 2004 (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.

                  (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

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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. In addition, the Company shall,
in accordance with the Company's relocation policy for senior executives,
reimburse Employee for expenses reasonably incurred by Employee in connection
with his relocation from Cleveland, Ohio to Nashville, Tennessee.

         4.       Duties, Extent of Services.

                  Employee is employed as Executive Vice President, Operations
of the Company and shall be generally responsible for overseeing the regional
dialysis operations of the Company. 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:

                  (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.

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                  (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 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

                                       -3-

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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. 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 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),
and (B) any unpaid bonus payable for the most recently completed calendar year.
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 (ii) three. If Employee
terminates his employment for Good Reason under clause (v) of Section 5(c)
above, then, in lieu of any 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.

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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
1(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 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

                                       -5-

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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.

                  (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 following 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.

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                  (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.

                  (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

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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 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.

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

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         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 and CEO

                                        EMPLOYEE:

                                        /s/ Timothy P. Martin
                                        ---------------------------------------
                                        TIMOTHY P. MARTIN

                                      -11-<PAGE>

                                                                   EXHIBIT 10.46

                              EMPLOYMENT AGREEMENT

         THIS AGREEMENT is made and entered into effective as of the 31st day of
December 2003, by and between RENAL CARE GROUP, INC., a Delaware corporation
(the "Company"), and DOUGLAS B. CHAPPELL (hereinafter "Employee").

                                   WITNESSETH:

         WHEREAS, Employee is currently Senior Vice President, General Counsel
and Secretary of the Company under an Employment Agreement effective as of
December 7, 1998 (the "Old Agreement"), and the Company desires to employ and
retain Employee to continue to act as its Senior Vice President, General Counsel
and Secretary; 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 December 31,
2003 (the "Effective Date").

         2.       Term.

                  The term of this Agreement shall begin on the Effective Date
and shall continue for an initial term of three years, ending on December 31,
2006 (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, subject to earlier termination as hereinafter provided, on the same
terms and conditions (subject to mutually agreeable modifications, if any).

         3.       Compensation and Benefits.

                  (a)      Base Compensation. The Company shall pay Employee a
base salary at an annual rate of $270,000 from the Effective Date through March
31, 2004 (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, provided that
Employee shall have at least four weeks of paid vacation time. In addition,
during the term of this Agreement, the Company will provide to Employee term
life insurance coverage of $500,000 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 40% 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 Senior Vice President, General Counsel
and Secretary of the Company. 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 from time to time by the Company. Throughout the term of this
Agreement, Employee will report to the Chief Executive Officer and President or
the Chairman of the Board of Directors 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:

                  (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,

                                       -2-

<PAGE>

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 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

                                       -3-

<PAGE>

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. 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 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),
and (B) any unpaid bonus payable for the most recently completed calendar year.
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 (ii) two. If Employee terminates
his employment for Good Reason under clause (v) of Section 5(c) above, then, in
lieu of any other compensation that may be specified herein, the Company will
pay Employee an amount equal to 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). 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

                                       -4-

<PAGE>

"previously reported") in response to Item 1(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 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. The parties acknowledge and agree that nothing in this Section
6(a) shall be deemed to restrict any firm of attorneys of or with which Employee
becomes an employee, partner, shareholder, counsel or otherwise associated or
affiliated from rendering legal services to any business entity or entities that
are competitive with the business of the Company or its affiliates, so long as
Employee does not perform

                                       -5-

<PAGE>

services for any such business entity and that such entity or entities do not
represent more than fifty percent (50%) of the revenue of such firm in any
twelve (12)-month period.

                  (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.

                  (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 following 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.

                                       -6-

<PAGE>

                  (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.

                  (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

                                       -7-

<PAGE>

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 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-

<PAGE>

         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,
specifically including the Old Agreement. 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 address: c/o Renal Care Group, Inc., 2525 West End Avenue, Suite 600,
Nashville, Tennessee 37203, Attention: General Counsel.

                                       -9-

<PAGE>

         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: /s/ President and CEO

                                        EMPLOYEE:

                                        /s/ Douglas B. Chappell
                                        ----------------------------------------
                                        DOUGLAS B. CHAPPELL

                                      -11-

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