BACKGROUND: The relationship among higher peritoneal protein clearance (PPCl), fluid overload, and increased risk of cardiovascular (CV) events has not been well clarified in peritoneal dialysis (PD) patients. We aimed to examine their associations in a prospective cohort study. METHODS: Eligible patients were enrolled from a single center, and PPCl was calculated based on the daily dialysate protein loss corrected for serum albumin. Fluid overload was defined as extracellular water (ECW)/total body water (TBW) ≥0.400 measured by bioelectrical impedance analysis (BIA). The primary outcome was CV events. RESULTS: In total, 351 patients were included in this study. After adjustment for confounders, every 5 mL/day increase in PPCl was independently associated with a 27% higher risk of fluid overload determined by BIA (odds ratio: 1.27, 95% confidence interval (CI): 1.17-1.37). After a median follow-up of 46.8 months, 90 patients (25.6%) experienced CV events. In competing risk models adjusted for confounders, both fluid overload and every 5 mL/day increase in PPCl were independently associated with 70% (subdistribution hazard ratio (SHR):1.70, 95%CI: 1.06-2.74) and 9% (SHR: 1.09, 95%CI: 1.04-1.14) increased risk of CV events, respectively. When fluid overload and PPCl were added simultaneously to the models, PPCl remained a strong independent predictor (SHR: 1.07
95%CI: 1.03-1.13). CONCLUSIONS: Higher PPCl was independently associated with fluid overload determined by BIA in PD patients. Moreover, higher PPCl was independently associated with an increased risk of CV events.