Better control of cardiovascular function in patients on peritoneal dialysis (PD) is critical because PD patients have a tendency to overhydration, which has been proved to be associated with cardiovascular and patient outcome. In the general population, lipid metabolism is also considered to be an important indicator of future cardiovascular events. Icodextrin has been used to improve ultrafiltration volume without increasing dextrose load. We therefore expected that parameters of lipid metabolism and cardiovascular function could both be improved, or at least maintained, after icodextrin use in PD patients. We therefore analyzed those parameters in 14 prevalent PD patients who required a switch from dextrose to icodextrin solution for the long dwell at 1 year before the switch, at the time of the switch, and at 1 and 2 years after the switch. In the study patients, cardiovascular remodeling evaluated by ultrasonographic left ventricular mass index was diminished, but the intima media area of the cervical artery was elevated after icodextrin use. Intima media thickness did not change over time. Biochemical indices such as brain natriuretic peptide, atrial natriuretic peptide, lipoprotein A, total cholesterol, and triglycerides were all lower after icodextrin use. These results indicate that icodextrin has the potential to improve lipid metabolism, volemic status, and cardiac hypertrophy in prevalent PD patients. However, atherosclerotic vascular change is refractory to improvement.