Cytokines and intercellular adhesion molecule (ICAM) play a crucial role in the pathogenesis of primary kidney disease and progression to end-stage renal disease (ESRD). Cytokine secretion is reported to be dependent on the single nucleotide polymorphisms located in the cytokine genes. The role of different polymorphisms in cytokines and ICAM genes as probable susceptibility factors for ESRD has been explored in the present study. The study was conducted on 258 ESRD patients and on ethnically matched 569 controls. Individuals were genotyped for interleukin (IL)-6 (G174C), IL-4 (C590T), tumor necrosis factor-alpha (TNF-alpha) (-G308A and -G238A) and ICAM-1 (A469G) gene polymorphisms using standard polymerase chain reaction-restriction fragment length polymorphism-based method. We observed significant difference in the genotype frequencies of the TNF-alpha-308AA [P = 0.001; odds ratios (OR) = 7.61, 95% confidence intervals (CI) = 2.1-27.9] and TNF-alpha-238AA (P = 0.001; OR = 5.8, 95% CI = 2.2-15.1). Furthermore, C allele of IL-6 -G174C and G allele of ICAM-1 A469G were significantly different in ESRD patients when compared with controls (P = 0.0001; OR = 5.5, 95% CI = 3.9-7.7 and P < 0.0001; OR = 3.8, 95% CI = 3.1-4.7). For the IL-4 C590T polymorphism, although the homozygous mutant genotype (TT) was not found to be significantly associated with ESRD, a statistically significant association with T allele (P = 0.008) was observed. Furthermore, combined analysis showed a higher risk in ESRD patients with high IL-4- and low IL-6-producing genotypes, low IL-4- and low IL-6-producing genotypes and high-producing genotype of TNF-alpha (308 and 238) with the increased risk of 6.47-, 3.7- and 3.3-fold, respectively. Our results suggest that IL-6, IL-4, TNF-alpha and ICAM gene polymorphisms are implicated in ESRD.