OBJECTIVES: The main objective of the study is to compare and analyze the costs of various renal replacement interventions (dialysis, and renal transplantation). METHODS:  A cross-sectional observational study was conducted at KIMS Hospital, Hyderabad, India for a period of six months. All the renal replacement therapy patients willingness to participate in the study was included. The data collected were cost of dialysis, renal transplantation, medications, consultation fee, transportation cost. We analyzed the average monthly and annual cost of Renal Replacement Therapies (RRT). RESULTS:  A total of 100 patients were enrolled during the study period. Out of 100 patients, 80 dialysis and 20 renal transplantation patients, majorities of them were in the age group of 41-60 year 66(66%) and men 63(63%) followed by women 37(37%). The cost for the dialysis for each time is Rs.1250. The average frequency of dialysis three times per week. The average monthly and annual cost of dialysis per patients was found to be Rs.15000 and Rs.1,80,000. The cost for the transplantation procedure was found to be Rs.1,40,000. The most commonly used Immunosuppressive agents were Tacrolimus, Mycophenolate Mofetil and Deflazacort. The average monthly costs of Immunosuppressive agents were Rs.8160-16000, Rs.2400-4800 and Rs.600-800 respectively. The average consultation fee for each time was found to be Rs.350. CONCLUSIONS: They are also several approaches to reduce the annual cost of renal replacement therapy (RRT). Obviously in long term, the most important factor is to reduce the number of patients with ESRD. This can be achieved by preventing the progression of renal disease. In India, the most frequent causes of ESRD are diabetes and hypertension. Early detection and treatment of these diseases play a vital role in the prevention of progression of renal failure and to postpone the need of RRT to an extent.