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. This evidence concerns the gene ADIPOQ and nutritional deficiency disease.