There is a grievance process and every dialysis patient should be informed of it. Usually the steps include making your complaint known within the clinic first to allow the clinic to try to work on it. I had patients that talked with me about their concerns. Most of the time we were able to come up with solutions. Patients may be nervous to complain to their clinic for fear of being labeled as troublemakers. Patients can complain to the corporate office of their dialysis clinic if it is part of a large corporation or to the owner if the clinic is independent. They can also complain to their ESRD Network (www.esrdnetworks.org). They can complain to the state survey agency (see www.cms.hhs.gov/apps/contacts/, your state, and choose “ESRD state survey agency”). Incidentally, patient complaints to the state survey agency about care received at dialysis clinics have led to surprise inspections.