It has been suggested that a deficient immune response can be responsible at least partially for the high risk of infections and neoplasia in uremic patients. Since interferon (IFN) is critical to the immune response, we have evaluated the in vitro production of IFN-gamma and other lymphokines by peripheral blood mononuclear cells (PBMC) drawn from patients with end-stage renal disease and appropriate controls. We have correlated production of lymphokines by these cells with proliferative response to different mitogens. It was found that the secretion of IFN-gamma in response to all three mitogens was elevated in these patients compared with the control group. This elevation was significant with both phytohemagglutin and staphylococcal enterotoxin A, but not with Con A. No significant difference was observed in production of lymphotoxins, IL-2, and leukocyte migration inhibition responses. In contrast the proliferative response appeared diminished in the PBMC of uremic patients. We concluded that defective lymphokine generation is not a major immunological problem in patients with end-stage renal disease. Indeed, they appear to release excess amount of IFN-gamma which is known to be a macrophage-activating factor. It is suggested that high IFN-gamma activity could enhance the secretion of IL-1 or endogenous pyrogen and result in development of febrile reactions in dialysis patients.