Objective  To investigate the predictive value of serum Wnt family member 3A (Wnt3A), serum uric acid/creatinine ratio (SUA/Scr), and adropin for the prognosis of uremic hemodialysis patients based on receiver operating characteristic (ROC) curve and decision curve analysis (DCA).  Methods Patients undergoing hemodialysis at the 305th Hospital of the People's Liberation Army of China from September 2022 to September 2024 were prospectively enrolled as the study group and divided into poor‑prognosis and good‑prognosis subgroups based on 1‑year follow‑up outcomes. Non‑hemodialysis patients with chronic kidney disease (CKD) during the same period were selected as the control group. Serum levels of Wnt3A and adropin were measured by enzyme‑linked immunosorbent assay, and SUA and Scr were determined using an automated biochemical analyzer, with SUA/Scr calculated accordingly. Multivariate logistic regression was used to analyze prognostic factors. ROC curve analysis was performed to evaluate the predictive value of Wnt3A, SUA/Scr, and adropin for prognosis, and DCA was applied to assess the clinical utility of the prediction model.  Results  A total of 204 patients were enrolled in each group. The study group had significantly higher Wnt3A and lower SUA/Scr and adropin levels than the control group (t/Z = 8.377, 14.621, and 12.759, respectively, all P＜0.001). Based on 1-year follow-up, the study group was divided into the good-prognosis (n=141) and poor-prognosis (n=63) subgroups. Patients in the poor-prognosis subgroup had significantly higher Wnt3A and SUA/Scr and lower adropin levels compared with the good-prognosis subgroup (t/Z = 8.138, 6.934, and 10.811, respectively, all P＜0.001). Multivariate logistic regression identified age, dialysis vintage, intact parathyroid hormone, Wnt3A, SUA/Scr, and adropin as factors influencing poor prognosis [OR=1.261 (95% CI: 1.049～1.516), 1.762 (95% CI: 1.177～2.638), 1.553 (95% CI: 1.171～2.059), 1.892 (95% CI: 1.319～2.714), 1.942 (95% CI: 1.310～2.880), and 0.449 (95% CI: 0.270～0.746), with P=0.014, 0.006, 0.002, 0.001, 0.001, and 0.002, respectively]. ROC analysis showed that the area under the curve (AUC) for the combined prediction of poor prognosis using Wnt3A, SUA/Scr, and adropin was 0.953 (95% CI: 0.928～0.979), which was significantly greater than that of each marker alone [Wnt3A: AUC=0.803, SUA/Scr: AUC=0.822, adropin: AUC=0.837; Z values vs. combined model were 4.121, 3.693, and 3.650, respectively, all P＜0.001]. DCA results indicated that the combined prediction model provided a higher net benefit than each individual marker across threshold probabilities ranging from 0.04 to 0.95.  Conclusion  In hemodialysis patients with poor prognosis, serum Wnt3A and SUA/Scr levels are elevated while adropin level is decreased. The combined detection of these three markers offers superior predictive value for prognosis.