To better elucidate the impact of the uremic adipokines, leptin and adiponectin, in the end-stage kidney disease population, we sought to examine the associations of serum L/A ratios and mortality risk in a well-characterized, diverse, multi-center prospective cohort of hemodialysis patients from the NIH Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (MADRAD) (NCT01415570) study. The gene discussed is LEP; the disease is nutritional deficiency disease.