Abstract Background and Aims There are limited data on the association of gut permeability, circulating bacterial fragment load, left ventricular strain in patients on peritoneal dialysis (PD). We aimed to measure circulating bacterial fragments, NT-proBNP, calprotectin and zonulin levels, and to evaluate their association with gut permeability, circulating bacterial fragment load, left ventricular strain and clinical outcomes on PD patients. Method We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. Serum endotoxin, bacterial DNA, NT-proBNP, calprotectin and zonulin levels were measured. Primary outcomes were technical and patient survival, secondary outcomes were hospitalization data. Results One hundred and eight patients were recruited. No correlations between circulating bacterial fragments, NT-proBNP, calprotectin and zonulin levels in PD patients. Circulating bacterial fragments, calprotectin and zonulin levels are positively correlated with insulin resistance index (bacterial DNA: P = .002, calprotectin: P = .014, zonulin: P = .006), while NT-proBNP level is associated with volume overload in PD patients (volume of overhydration: P = .000, E:I ratio: P = .000), peritoneal characteristics (D/P4: P = .004, MTAC: P = .048). NT-proBNP level have a negative correlation with nutritional characteristics (albumin: P = .000, hemoglobin: P = .033) and residual GFR (P = .000). In univariate analysis of PD patient survival, NT-proBNP is associated with patient survival (P = .003), but this association become insignificant after multivariate analysis of clinical confounding factors. NT-proBNP is the strongest independent predictor of technical survival rate in PD patients (P = .005). Patients in the highest tertiles of NT-proBNP and calprotectin have lower technical survival rates, but only patients in the highest tertiles of NT-proBNP, not calprotectin, have lower patient survival. NT-proBNP is also correlated with the number of hospitalizations per year (P = .004) and total hospitalization time (P = .012) in PD patients. Endotoxin and bacterial DNA levels in PD patients have no predictive value for PD patient survival, technical survival, number of hospitalizations per year, and total hospitalization time. Conclusion There is no correlation between gut permeability, circulating bacterial fragments, and impairment of left ventricular function in PD patients. Circulating bacterial fragments levels and gut permeability are associated with insulin resistance, while impairment of left ventricular function is associated with solution overload. Bacterial fragment levels have no predictive value on survival rate, technical survival rate and hospitalizations data in PD patients. NT-proBNP is the strongest independent predictor of technical survival rate in PD patients.