BACKGROUND Raw shellfish-associated Vibrio vulnificus septicemia, with a case-fatality rate of nearly 50%, occurs most commonly in immunocompromised patients or those with liver disease. METHODS Sixty patients with renal disease treated with hemodialysis at The George Washington University and awaiting renal transplantation completed an initial survey that assessed their raw shellfish eating habits and knowledge regarding the pathogen V. vulnificus. Patients were then given educational materials describing the risks of eating raw shellfish and, one month later, completed a second survey that assessed their knowledge retention and intent to eat or not eat raw shellfish in the future. RESULTS Sixty of 68 (88%) eligible patients completed the survey. Forty-eight percent of patients reported having eaten raw shellfish after being diagnosed with kidney disease, with the highest rates reported among subjects < or = 49 years old and subjects with more than a high school education. Prior to receiving the educational materials, no patient had heard of the pathogen V. vulnificus. Three quarters of patients reported never having been advised by a physician to avoid eating raw shellfish. One month after reading the educational materials, 75% of patients said they would refrain from eating raw shellfish in the future. CONCLUSIONS In view of their immunocompromised status, patients with end-stage renal disease should be counseled to abstain from eating raw shellfish.