【Abstract】Objective To investigate the levels of serum calcium, serum phosphorus and iPTH to influence and predict the heart failure (HF) in maintenance peritoneal dialysis (MPD) patients. Methods A total of 322 MPD patients treated in our hospitals from January 2014 to October 2018 were recruited in this retrospective and multicenter clinical study. Based on morning fasting serum phosphate level (Pi), patients were divided into high phosphorus group (Pi≥1.6mmol/L, n=143), low phosphorus group (Pi ≤0.8mmol/L, n=21) and normal phosphorus group (0.8mmol/L＜ Pi ＜1.6mmol/L, n=158). They were followed up for more than 3 months, and the presence of HF events was recorded. Clinical data, peritoneal dialysis indices, laboratory examinations and echocardiographic parameters were compared between the 3 groups. The correlation of calcium/phosphorus metabolism and other clinical parameters with HF was analyzed. The effect of calcium/phosphorus metabolism on survival of the MPD patients with HF was assessed by Kaplan-Meier curve method. Multivariate logistic regression model was used to evaluate the risk factors for HF in MPD patients. SPSS20.0 was used for the statistical analyses, and P<0.05 was considered to be statistically significant. Results ①HF was found in 179 cases within the follow-up period of 25.46±16.98 months. The prevalence of HF was higher in high phosphorus group (69.2% ) than in low phosphorus group (4.8% ) and normal phosphorus group (50.0%) (F=17.386, P=0.016). ②There were statistical differences in dialysis age (F=202.706, P=0.009) and serum albumin (F=84.193, P=0.020) between the 3 groups. ③ Kaplan- Meier curve method revealed that MPD patients with low calcium, high phosphorus and high iPTH were at high risk of HF (P=0.002). ④ Multivariate logistic regression model found that higher serum phosphorus and iPTH were the risk factors for HF in MPD patients (OR=1.231 and 1.003 respectively; 95% CI=1.023～4.634 and 1.000～1.006 respectively; P=0.004 and 0.030 respectively). Conclusions Higher levels of serum phosphorus and iPTH are the independent risk factors for HF in MPD patients, and MPD patients with lower serum calcium accompanied by higher levels of phosphorus and higher iPTH will have higher risk of HF. Therefore, treatment for the disorders of calcium and phosphorus metabolism is an essential method for the prevention of HF in MPD patients.