The present study examined associations between negative family exchanges (patient perceptions of family overprotection and negative expressiveness, and patient feelings of being a burden), and two indicators of adaptation to illness (mental health and negative affect) in patients with end-stage renal disease (ESRD). Data were collected using the perceptions of illness-related family exchanges questionnaire, the SF36 and the PANAS in a structured interview with 127 patients with ESRD in Greece. Findings indicate that patient perceptions of negative family exchanges are related to outcomes, even after controlling for demographic and clinical factors. It is important to consider caregivers in intervention programmes of ESRD patients.