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Early mortality rates of female patients on dialysis have been, at times, observed to be higher than rates among male patients. The differences in cause-specific mortality between male and female incident dialysis patients with kidney failure are not well understood and were the focus of this study.Retrospective cohort study.Participants: Incident patients who had initiated dialysis in Australia and New Zealand between 1998-2018.Sex.Cause-specific and all-cause mortality on dialysis, censored for kidney transplantation.Adjusted cause-specific proportional hazards models, focusing on the first 5 years following initiation of dialysis.Among 53,414 patients (20,876 [39%] of whom were female) followed for a median period of 2.8 (IQR 1.3-5.2) years, 27,137 (51%) died, with the predominant cause of death attributed to cardiovascular disease (CVD, 18%), followed by dialysis withdrawal (16%). Compared to male patients, female patients were more likely to die in the first 5 years after dialysis initiation (adjusted hazard ratio (aHR) of 1.06 [95% CI 1.03-1.09]). Even though female patients experienced a lower risk of CVD-related mortality (aHR 0.93 [0.89-0.98]) compared to male patients, they experienced a greater risk of infection-related (aHR 1.20 [1.10-1.32]) and dialysis withdrawal-related mortality (aHR 1.19 [1.13-1.26]).Possibility of residual and unmeasured confounders.Compared with male patients, female patients had a higher risk of all-cause mortality in the first 5 years post-dialysis initiation, a difference driven by higher mortality from infections and dialysis withdrawals. These findings may inform the study of sex differences in mortality in other geographic settings.