Background: Asia is a huge and populous continent with diverse economies where the status of renal replacement therapy varies among different countries. Summary: The penetration of dialysis is poor among low income countries like India and China. A lack of trained nephrologists and limited numbers of dialysis facilities plague South Asian countries. Most of the hemodialysis centers are in the private sector; the few centers that are government-run or run by charitable organizations cannot meet growing needs. China has shown that twice-a-week hemodialysis can be feasible in female patients with small build. Peritoneal dialysis (PD) has less penetration among the developing countries than the developed countries in Asia. Novel schemes in India including the ‘once-in-a-lifetime payment' scheme and an insurance scheme for peritonitis are attracting more patients to PD. New biocompatible PD solutions and home care facilities have brought down the peritonitis rates. The PD-first policy in Thailand alongside the domestic manufacture of PD fluids has decreased the cost of PD there. Iran has shown drastic changes in its PD policy (from 0 to 1,150 recruitments in 5 years) in spite of its high transplantation rate. Home hemodialysis is practiced in mostly affluent countries like Japan, where again it accounts for only 0.1% of all hemodialysis. Key Messages: Developing countries should have more budgetary allocation for chronic ailments such as chronic kidney disease that can be utilized for training programs and establishing dialysis units, and thus meet the growing demands for renal replacement therapy. PD should be encouraged and adopted as first modality of renal replacement therapy considering its ease and economy.