Objectives: Fluid overload and malnutrition have been known to be associated with high morbidity and mortality in patients with end stage renal disease. In this population, higher extracellular fluid (ECF) volume reflects fluid overload and lower intracellular fluid (ICF) volume reflects malnutrition. Recently, high ECF/ICF ratio was shown to be associated with increased risk of all-cause mortality and cardiovascular events (CVEs) in hemodialysis patients. However, it has not been confirmed yet whether this relationship is equally observed in peritoneal dialysis (PD) patients. Therefore, we investigated the relationship between ECF/ICF ratio and survival and CVE in PD patients.  Methods: A total of sixty eight prevalent PD patients from a single dialysis center were enrolled. The ECF/ICF ratio was measured by bioelectrical impedance spectroscopy using Body Composition Monitor (BCM). We accessed the association of ECF/ICF ratio with a composite outcome of death and CVEs using cox regression analysis.  Results: The mean value of ECF/ICF ratio was 0.96±0.14. The highest tertile of ECF/ICF group had higher systolic blood pressure and are more prevalent in diabetes patients, but they had lower serum albumin and intact parathyroid hormone level, compared with other tertiles of ECF/ICF group. In unadjusted cox regression analysis, the highest tertile of CEF/ICF ratio was significantly associated with increased risk of death and CVEs (HR, 4.039; 95% CI, 1.413-11.547, P=0.009). The significant association of high ECF/ICF ratio with the composite outcome was also maintained in adjusted cox regression analysis (HR, 3.846; 95% CI, 1.024-14.450; P=0.046).  Conclusions: High ECF/ICF ratio is significantly associated with increased risk of death and CVEs in PD patients suggesting that the ECF/ICF ratio may be a novel risk factor for all-cause mortality and CVEs.