Australian Aborigines experience end‐stage renal disease at 10 times the national average. Although contributing physiological factors have been widely discussed, there has been little research into cultural factors affecting treatment and outcomes. This paper discusses folk and lay understandings of renal physiology and disease aetiology, and social and cultural factors in dialysis and transplantation, in a group of Aboriginal and Torres Strait Island renal transplant recipients. The implications for service delivery include the need for improved and clear information regarding renal disease and treatment and for culturally appropriate and acceptable support systems. Beliefs that continued alcohol consumption and poor nutrition were major reasons for kidney failure and separation from kin and country emerged as significant factors affecting treatment and leading to poor outcomes.

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