Objective: The aim of this paper is to determine the causes and outcomes of end-stage chronic kidney disease in children in Dalmatia who were treated at the Children's Disease Clinic at the Split Clinical Hospital Center in the last fifteen years, that is, in the period from January 2009 to January 2024. Subjects and methods: This retrospective cross-sectional study included 22 pediatric patients with end-stage CKD (including preemptively transplanted ones) treated at the KBC Split Pediatric Clinic in the period from January 2009 to January 2024. The data was collected by searching the hospital records of 22 patients of the Clinic for Children's Diseases, and the following data were analyzed: gender, age of entry into the 5th (final) stage of CKD, etiology of CKD, number of patients treated conservatively, dialyzed and transplanted, duration of dialysis treatment and most common complications, the number and type of transplants including preemptive, living donor and cadaveric transplants, the number of rejected transplants and the number of patients who were transplanted again. Due to the lack of medical documentation, some of the patients' parents were contacted by phone. The collected data were entered into the Microsoft Excel program and statistically processed. Results: Out of a total of 22 patients, 68% were male while 32% were female. The most common cause of CKD is posterior urethral valve with hypoplastic-dysplastic kidneys (27.3%). The average age when entering the 5th stage of CKD is 9 years and 5 months, while the median is 8 years and 10 months. Of the 22 patients with end-stage CKD, all were treated conservatively at some point, 63.6% were on peritoneal dialysis, while 77.27% of the patients were transplanted, of which 17.65% were preemptively transplanted. The average duration of dialysis treatment is 3 years and 7 months. The most common complication of dialysis treatment was catheter replacement (78.57%), followed by peritonitis (50%). In 71% of cases, the causative agent of peritonitis was isolated. The most common cause of peritonitis is MSSA (42.85%). The majority of transplants were performed at the Reference Center in Zagreb (76.47%). Most patients received a cadaveric kidney (58.82%). The current treatment modalities as of January 2024 are as follows: 5 patients are being treated conservatively, and of the 17 initially transplanted, 2 patients rejected the transplant and are currently undergoing dialysis treatment. Conclusions: Congenital anomalies of the urinary system account for 50% of the causes of end-stage CKD in the pediatric population of Dalmatia. Most patients were transplanted (77.27%). Two patients rejected the graft and are currently undergoing dialysis treatment (9.1%).