The role of paid work in chronic illness has been investigated in this nation-wide study of all Swedish-speaking patients on chronic dialysis above the age of 16 years, who were not too tired or severely ill to participate and who had been treated for at least 3 months. Young age and female gender were consistently associated with increased prevalence of self-reported depression, poor psychological health, psychosomatic symptoms and sleep disturbance. In multivariate analyses paid work, strong emotional support, and care at intermediate or small units were independently associated with a good quality of life. Chronic dialysis patients who did paid work (19.6% of the patients below 65 years of age) perceived their work as more socially supportive than did men and women in the normal working population. It may be concluded that paid work is of particular importance to this patient group because it may give extra social support to patients whose social network is in general rather poor.