Background <p>The E/e′ ratio is recognized as a reliable and sensitive echocardiographic marker of left ventricular diastolic dysfunction (LVDD). Increased E/e′ is known to be associated with mortality and cardiovascular events in kidney failure patients undergoing maintenance replacement therapy. To elucidate the prognostic significance of E/e′ in patients starting peritoneal dialysis (PD), we investigated the relations between baseline E/e′ after PD initiation and death or PD discontinuation.</p> Methods <p>Data were collected retrospectively from patients with the E/e′ ratio evaluated early after PD initiation during August 2008 through December 2023. We investigated the association between the average of septal and lateral E/e′ (E/e′ Avg) and a composite outcome comprising mortality and PD discontinuation within 8&#xa0;years after PD initiation.</p> Results <p>This study included 74 incident PD patients with median age of 64&#xa0;years (74% male). The median value of E/e′ Avg was 9.4 at the median time of 3.3&#xa0;months after PD initiation. Based on the cut-off value inferred from receiver operating characteristic analysis, patients were divided into two groups: patients with E/e′ Avg ≤ 9.0 and with E/e′ Avg &gt; 9.0. Kaplan–Meier analysis indicated the 8-year survival and PD continuation rates as significantly lower for the E/e′ Avg &gt; 9.0 group than for the E/e′ Avg ≤ 9.0 group (<i>p</i> = .0019). Cox proportional hazards analyses showed E/e′ Avg as independently associated with the composite outcome (hazard ratio 1.17, 95% confidence interval 1.07–1.28).</p> Conclusion <p>Increased E/e′ Avg early after PD initiation is associated positively with 8-year mortality and PD discontinuation.</p>