Success of coronary stenting is limited by in-stent restenosis. We aimed to determine whether circulating levels of adiponectin could be associated with the occurrence of coronary in-stent restenosis in patients with end-stage renal disease (ESRD). We enrolled 71 consecutive ESRD patients undergoing hemodialysis (mean age: 64.9 +/- 8.9 years; 19 women, 52 men; mean hemodialysis duration: 78.2 +/- 87.5 months), who received stenting for a single coronary lesion. Plasma adiponectin concentrations were measured within one week before coronary stenting. Of 71 patients who had received stenting, in-stent restenosis occurred in 37 patients (52.1%) within 6 months after stenting. In univariate logistic analysis, homeostasis model assessment index of insulin resistance, blood hemoglobin, serum concentrations of high density lipoprotein cholesterol or triglycerides, and plasma concentrations of insulin or adiponectin were significantly associated with coronary in-stent restenosis. In multiple logistic regression analysis among these variables, however, only the plasma adiponectin concentration was associated with the coronary in-stent restenosis: the odds ratio of increase in 1 microg/ml of plasma adiponectin concentration for having restenosis was 0.651 (p = 0.001, 95% confidence interval: 0.506-0.839). Patients with restenosis had lower plasma adiponectin concentrations than those without [6.2 +/- 2.2 microg/ml (2.1-10.4 microg/ml; n=37) versus 27.2 +/- 10.8 microg/ml (17.9-79.8 microg/ml; n=34); p = 0.0001]. Circulating adiponectin concentrations may be associated with the occurrence of coronary in-stent restenosis in ESRD patients undergoing maintenance hemodialysis.