Care of patients with end-stage renal disease (ESRD) is essential but also resource intense. We review several studies on online hemodiafiltration (OL-HDF), which concluded that high-volume OL-HDF is associated with better outcome compared to conventional hemodialysis. The cost-effectiveness of OL-HDF was shown in many studies. For example, in the Canadian setting of the Convective Transport Study (CONTRAST), the high-efficiency OL-HDF was shown to be cost-effective compared with low-flux hemodialysis (LF-HD) for patients with ESRD. In our study (Al Saran et al.), it was shown that the cost of hemodialysis was quite less in Saudi Arabia than in other industrialized countries while maintaining a high standard of care. In our retrospective analysis of the cost of OL-HDF in the same center, it was only 3% higher than the conventional HD, which indicates that it is cost-effective considering the improved hospitalization rate, the mortality rates, and the likely better quality of life associated with it. The trend of increased practice of OL-HDF may encourage the practice of home OL-HDF as well. It has been shown that home HD is more costeffective than in-center HD and we presume that the same results will be applied to home OL-HDF as well.