Combined Assessment of Serum dp-ucMGP and Albumin in Relation to All-Cause and Cardiovascular Mortality in Hemodialysis Patients

Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) is considered a marker of vitamin K status and vascular calcification risk in chronic kidney disease. This study assessed the association of serum dp-ucMGP, alone and combined with albumin, with all-cause and cardiovascular mortality in maintenance hemodialysis patients. This single-center observational cohort study included 133 maintenance hemodialysis patients with a two-year survival follow-up. Analyses involving dp-ucMGP and albumin were performed in 113 patients with complete biomarker data. Baseline serum dp-ucMGP, albumin, inflammatory markers, and routine laboratory parameters were measured. Associations with all-cause and cardiovascular mortality were evaluated using group comparisons, ROC curve analysis, Kaplan-Meier analysis, and Cox regression. Patients who died had significantly lower dp-ucMGP and albumin levels and higher inflammatory and hematological indices than survivors, with similar findings for cardiovascular mortality. The combined dp-ucMGP-albumin model showed higher apparent discriminatory performance than either marker alone for all-cause mortality (AUC 0.793, 95% CI 0.708-0.878, p < 0.001) and cardiovascular mortality (AUC 0.778, 95% CI 0.687-0.868, p < 0.001). Lower dp-ucMGP levels were associated with worse survival. In multivariable Cox regression, higher dp-ucMGP and albumin were independently associated with lower mortality. Combined dp-ucMGP and albumin assessment may provide complementary prognostic information in hemodialysis patients but requires validation in larger cohorts.