Introduction: Arterial stiffness is an important contributor to the increased cardiovascular burden of uremia. The aim of the study was to identify determinants of arterial stiffness progression in peritoneal dialysis (PD) patients with strict volume control. Patients and methods: 89 prevalent PD patients were enrolled. Assessment of arterial stiffness was performed at baseline and after nine months on average (range 8 - 12 months) by carotid-femoral pulse wave velocity (cf-PWV). Results: Mean age was 51 +/- 13 y; preceeding time on PD was 40 +/- 34 months. 57% of the patients were men and 9% were diabetic. At baseline, mean cf-PWV was 8.7 +/- 2.7 m/s and was significantly higher in patients with diabetes and on automated PD therapy. Cf-PWV was positively correlated with age, history of cardiovascular disease, mean arterial pressure (MAP), blood glucose, left atrium diameter and left ventricular mass index. Sixty patients underwent a second cf-PWV measurement. 36% had progression of arterial stiffness. Delta cf-PWV value was 2.08 +/- 1.89 m/s for progressors and -1.25 +/- 1.43 m/s; p < 0.01 for non-progressors (p < 0.01). In logistic regression analysis, the change in MAP was the only predictor for progression of arterial stiffness. Conclusions: MAP is the main determinant of arterial stiffness progression. Our results suggest that efficient blood pressure control may contribute to preserved or reduced arterial stiffness in PD patients.