In Tanzania, acute renal failure may be a contributing factor to high mortality rates from priority diseases such as HIV/AIDS and malaria. When treated in a timely manner, full restoration of kidney function may be achieved by providing support with peritoneal dialysis (PD). This project aimed to establish an acute PD program at Kilimanjaro Christian Medical Center, a referral hospital in Moshi, Tanzania. Costs of the program have been offset by the Sustainable Kidney Care Foundation. Two physicians and two nurses from KCMC were trained on PD catheter insertion and management of PD in Brazil. They now mentor junior trainees to ensure technique survival. Eligible patients must have presumed recoverable acute kidney injury, with no evidence of chronicity. Each case is discussed with a supporting group of nephrologists based in North America. Twenty-four patients have been dialyzed from July 2009 to May 2012. The most common cause of acute renal failure was acute tubular necrosis and the mean age was 28 years. There were five pediatric patients, including one infant, and three patients with pregnancy-related renal disease. Eighteen patients recovered renal function by the time of discharge. We have established a sustainable acute PD program in Moshi, Tanzania. Ongoing program challenges include lack of patient referrals, financial constraints, ongoing staff training, and access to timely laboratory services.