Background <p>Encapsulating peritoneal sclerosis (EPS) can result in abdominal organ encasement, and bowel obstruction, and is associated with a high mortality rate. While various risk factors have been identified for the development of EPS, the factors influencing patient outcomes in EPS are less well-studied. This study aims to investigate the prognostic factors that affect the clinical course and survival of EPS patients.</p> Methods <p>In this retrospective study, we examined a cohort of 1406 peritoneal dialysis (PD) patients over an 18-year study period. Among them, 35 individuals were diagnosed with EPS. We collected data encompassing demographic characteristics, comorbidities, PD-related parameters, clinical symptoms, computed tomography scores, laboratory results, and treatment modalities. The survival analysis incorporated both univariate and multivariate Cox regression models, as well as the Kaplan-Meier method.</p> Results <p>Patients with EPS exhibited a spectrum of clinical symptoms, with intestinal obstruction occurring in 88.6% and ultrafiltration failure in 42.9%. The five-year survival rate was 26.3%, and malnutrition and gastrointestinal infections contributed to three-fourths of the deaths. A notable finding was the one-month drop in albumin levels as a marker of ongoing malabsorption, demonstrating its predictive value for both overall (HR 2.01, <i>p</i> = 0.042) and EPS-related (HR 2.79, <i>p</i> = 0.017) mortality.</p> Conclusions <p>This study emphasizes the crucial role of monitoring the one-month albumin drop after EPS diagnosis, providing valuable insights for the improvement of clinical management and patient care.</p>