Cardiovascular disease accounts for more than half of all deaths in end-stage renal disease patients receiving chronic peritoneal dialysis (PD) treatment. The recent demonstration of the important association between residual renal clearance (but not PD clearance) and overall and cardiovascular survival in chronic PD patients has led us to further explore the mechanisms that can potentially explain the close link between residual renal function and cardiovascular disease in this population. This John Maher Award Lecture provides a review of my own work and that of other groups that provides support for the importance of residual renal function not only in providing small-solute clearance but also in maintaining the cardiovascular health, nutrition status, and wellbeing of PD patients. Data are provided to demonstrate why preservation of residual renal function may be the key to improving survival and cardiovascular outcomes in PD patients.