<p><b><i>Background:</i></b> Previous reports showed an increased early
mortality after chronic dialysis initiation among the end-stage renal
disease (ESRD) population. We hypothesized that ESRD patients in the
Military Health System (MHS) would have greater access to pre-ESRD care
and hence better survival rates during this early high-risk period. <b><i>Methods:</i></b>
In this retrospective cohort study, using the US Renal Data System
database, we identified 1,256,640 patients initiated on chronic dialysis
from January 2, 2004 through December 31, 2014, from which a bootstrap
sample of 3,984 non-MHS incident dialysis patients were compared with
996 MHS patients. We assessed care by a nephrologist and dietitian,
erythropoietin administration, and vascular access use at dialysis
initiation as well as all-cause mortality as outcome variables. <b><i>Results:</i></b>
MHS patients were significantly more likely to have had pre-ESRD
nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and
arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI
1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week
for both cohorts but were reduced among MHS patients. The baseline
adjusted Cox model showed significantly lower death rates among MHS vs.
non-MHS patients at 6, 9, and 12 months. This survival advantage among
MHS patients was attenuated after further adjustment for pre-ESRD
nephrology care and dialysis vascular access. <b><i>Conclusions:</i></b>
MHS patients had improved survival within the first 12 months compared
to the general ESRD population, which may be explained in part by
differences in pre-ESRD nephrology care and vascular access types.</p