In this exploratory/descriptive study, the authors examined processes involved in some kidney patients' ability to survive on dialysis. Through long semistructured interviews with 18 dialysis survivors, they identified four self-affirmations that characterized participants' restructuring of self and four sets of illness experiences that required restructuring within the context of their extant worlds. The denouement involved the participants' transformation into comprehensive, active self-managers of their disease, its treatment, and its manifestations. The authors describe the participants' affirmations and adaptations leading to transformation. Understanding this process paves the way for research into the timing and sequence entailed in transformation and lays the groundwork for the development of interventions to guide kidney failure patients to the positive outcome of transformation: comprehensive, active self-management.