['In-center hemodialysis is the most prevalent (and resource-intense) form of dialysis in North America despite many patients being capable of performing dialysis themselves. The purpose of this study is to describe reasons in-center hemodialysis patients choose not to perform self-care dialysis and identify variables associated with a negative attitude toward self-care dialysis.', 'We conducted a cross-sectional survey (return rate, 83%) of prevalent in-center hemodialysis patients and combined this with demographic and comorbidity data obtained from our prospectively maintained database. We also performed multiple logistic regression to determine factors associated with the attitude, "patients should not perform dialysis without being supervised by a nurse."', 'The most prevalent knowledge barrier was lack of a satisfactory explanation of the various techniques. The most prevalent attitude barriers were that patients should not dialyze without direct supervision, fear of failure to perform self-care dialysis adequately, and fear of social isolation. The most prevalent skill barriers were needle phobia and lack of space at home. Variables significantly associated with a negative attitude toward self-care dialysis were age/fear of substandard care (interaction), needle phobia, fear of change, fear of social isolation, and unwillingness to remain awake during dialysis.'] Do why patients with ESRD select self-care dialysis as a treatment option?