To explore the significance of sense of humor for survival in a county cohort of patients diagnosed with end-stage renal failure. This diagnosis is a life-threatening condition that calls upon coping skills and regular dialysis. All patients receiving dialysis in the county of Sør-Trøndelag during February of one year (N= 52) were invited. Forty-one completed the survey and had complete data (78.9%). Predictors were related to survival status two years later. Three blocks of predictors were tested: 1) age, gender and education; 2) duration of disease, number of dialyses per week, and co-morbidity; and 3) quality of life and sense of humor. Confounding effects of variables in blocks one and two were controlled for using Cox survival analysis. Nineteen patients (46.3 %) died over the 2-year observation period. Survival decreased with higher age at time of survey (p < .044), but was not significantly predicted by variables in block two. A highly significant increase in survival was due to the psychological variables of block three (p <.001) essentially accounted for by sense of humor (p < .005). Those who scored above the median in sense of humor increased their odds for survival by on average 31%. Sense of humor appeared to mediate better coping and, therefore, protected against detrimental effects of disease-related stressors upon survival.