BACKGROUND: Evidence regarding bilirubin's antioxidant properties and predictive roles is growing. However, it is unclear whether serum bilirubin would have a prognostic impact on survival of patients with regular peritoneal dialysis. METHODS AND RESULTS: We used the Taiwan Renal Registry Data System utilizing its 2005-2012 data set. Data from patients on regular peritoneal dialysis were retrieved. The primary end point of observation was 3-year mortality. A total of 3704 patients (mean age 53.5 years, 44% male) were enrolled, and these patients were divided according to baseline serum total bilirubin levels (<0.3, 0.3-0.4, 0.4-0.5, 0.5-0.6, >0.6 mg/dL). Serum total bilirubin level was linearly related to age, incidence of hypertension, and type 2 diabetes mellitus. At the end of the observation period with a mean follow-up of 2.12±1.07 years, 1095 (30.6%) deaths were detected. Serum total bilirubin level and 3-year mortality rate presented a U-shaped relationship. Those with serum total bilirubin 0.5 to 0.6 mg/dL had the lowest 3-year mortality rate (24%). After adjustment for age, sex, underlying systemic disorders, medications, and laboratory discrepancies, serum total bilirubin still played an independent role for predicting 3-year mortality. CONCLUSIONS: Baseline serum total bilirubin level is significantly associated with 3-year mortality among patients receiving regular peritoneal dialysis.