Background:Cardiovascular disease(CVD)is the leading cause of death in dialysis patients.Little is known about the relationship of very low-density lipoprotein cholesterol(VLDL-C)with cardiovascular mortality in these patients.This study sought to evaluate the association of plasma VLDL-C with all-cause and cardiovascular mortality in peritoneal dialysis(PD)patients.Methods: A total of 1324 incident patients who began PD therapy at the First Affiliated Hospital of Zhejiang University in China between January 1,2005,and September 30,2014,with baseline serum VLDL-C values were investigated.All patients were followed until March 31,2015.The associations of the VLDL-C levelswith all-cause and cardiovascular mortality were assessed.Results: The mean age of the cohort was 50.2 ± 14.8 years,55.7%of the patients were males,and the mean VLDL-C level was 33.6 ± 18.0 mg/dl.One hundred sixtyfive(12.5%)patients died during the study period.Multivariable models revealed that the high VLDL-C group was associated with significantly higher all-cause(Cox model,HR,2.08,95%CI,1.13 to 3.29,P =0.002)and cardiovascular mortality(Cox model,HR,2.25,95%CI,1.18 to 4.29,P =0.013)compared with the low VLDL-C group even after adjusting for various covariates.Using the VLDL-C level as a continuous variable,the hazard ratios(HRs)of all-cause and cardiovascular mortality associated with a 10-mg/dl increase in VLDL-C level were 1.12(Cox model,95%CI,1.02 to 1.26,P =0.025)and 1.11(Cox model,95%CI,1.02 to 1.22,P =0.029),respectively.The results were similar when renal transplantation and transfer to HD were examined as competing events in the competing risks regression analysis Conclusions: An elevated VLDL-C level is an independent risk factor for all-cause and cardiovascular mortality in peritoneal dialysis patients.