Urgent-start peritoneal dialysis (PD) can be defined as initiation of PD within 2 weeks of catheter insertion. Urgent-start PD can be offered to patients who are referred late to a nephrologist and who would typically be initiated on hemodialysis with a temporary vascular access. An urgent-start PD capability requires expedited options education, catheter placement, unique change in the PD unit infrastructure, and new processes of care. This report describes the urgent-start PD program established by a nephrology private practice in the United States. Operational aspects of the program and initial clinical results are described.