PD is an underused modality for renal replacement therapy. Inadequate predialysis preparation, lack of adequate infrastructure, and concern over potential mechanical complications limit its uptake.1,2 Even so, urgent-start PD has been used successfully to treat patients presenting for unplanned initiation of dialysis therapy. Centers using low-volume recumbent PD have observed no difference in clinical outcomes of urgent versus planned PD starts.3-5 Fresenius Medical Care North America (FMCNA) recently initiated a large-scale urgent-start PD pilot; here, we report the early experiences.