A retrospective study of 475 patients with end-stage renal disease undergoing peritoneal dialysis (PD) from February 2010 to April 2025 analyzed risk factors for technical survival. The patients were divided into a training group (n=332) and a validation group (n=143). Spearman's analysis showed a negative correlation of PD duration with age, BMI, fasting blood glucose, serum creatinine, peritonitis, catheter complications, self-report score and depression (all p<0.05), a positive correlation with years of education, albumin level, number of caregivers and frequency of health education. Multivariate Cox analysis identified six independent risk factors: age ≥60 years (HR=9.084, 95% CI:5.912–13.959), diabetes mellitus (HR=15.047, 95% CI:9.802–23), low albumin level (HR=0.894, 95% CI:0.849–0.940), peritonitis (HR=6.172, 95% CI:3.970–9.595), catheter complications (HR=1.740, 95% CI:1.304–2.320) and abnormal mental status (HR=3.5217, p<0.01). The nomogram for predicting 1-, 3-, and 5-year technical survival performed well in both groups, as verified by ROC curves, C-index, calibration plots, and DCA. Nursing interventions such as health education (≥1 session/month), optimized care support, improved psychological conditions and balancing the urban-rural gap improve the prognosis of PD patients.