In a retrospective cohort study of 39 031 Veterans Healthcare Administration clinic users with diabetes and stage 3 or 4 chronic kidney disease during 1997 to 2000, consistency of outpatient nephrologic care was found to be independently associated in a graded fashion with lower dialysis-free mortality. Degree of consistency of visits to a nephrologist was defined as the number of calendar quarters (3 months) in which at least 1 visit occurred during a 12-month baseline period, ranging from 0 to 4. Adjusted hazard ratios (95% confidence intervals) were 0.80 (0.67-0.97), 0.68 (0.55-0.86), and 0.45 (0.32-0.63), when the groups of 2, 3, and 4 visits, respectively, were compared with those who had no visits. One visit only was not associated with a mortality difference when compared with no visits (adjusted hazard ratio, 1.02; 95% confidence interval, 0.89-1.16). Only a minority of patients visited a nephrologist in the baseline year: 3.1%, 9.5%, and 28.2% of patients in early stage 3, late stage 3, and stage 4 chronic kidney disease, respectively, visited a nephrologist.