Introduction The effect of dialysis modality on the survival of end-stage renal disease (ESRD) patients is a public health interest. Methods In this retrospective cohort study, all adult ESRD patients receiving dialysis treatment in Sabah between January 1, 2007 and December 31, 2017 as identified from the Malaysian Dialysis and Transplant Registry (MDTR) were evaluated and followed up through December 31, 2018. The endpoint was all-cause mortality. The observation time was defined as the time from the date of dialysis initiation after the onset of ESRD to whichever of the following that came first: date of death, date of transplantation, date of last follow-up, date of recovered kidney function, or December 31, 2018. Weighted Cox regression (WCR) was used to estimate the effect of dialysis modality. Analyses were restricted to patients with complete data on all variables. Results A total of 2,143 patients began haemodialysis (HD) and 303 patients started with peritoneal dialysis (PD), yielding 7,549.41 (median 5.48 years/person) and 1140.11 (median 5.08 years/person) person-years of observation. Seventy-two patients (2.9%) were lost to follow-up. The median survival time was 4.55 years (95% confidence interval (CI): 4.18, 4.85) among patients who started on HD and 5.23 years (95% CI: 4.31, 6.00) among those who started on PD. The effect of dialysis modality was not significant after controlling for age, sex, diabetes mellitus (DM), and cardiovascular diseases (CVD). The average hazard ratio (AHR) was 0.91 (95% CI: 0.77, 1.08) with HD as a reference. Conclusion There was no evidence of a difference in mortality between HD and PD. [This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/: Abstract text might vary slightly from what is displayed in the e-poster] ; This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/