The costs involved in the management of end-stage renal disease (ESRD) patients are overwhelming the healthcare commitments of countries worldwide and even more so in resource-limited settings. Some countries have intelligently managed to implement universal healthcare coverage for their citizens. Many others, unable to achieve this, have sensibly concentrated on spending their limited resources on less expensive but more important healthcare issues, such as preventive care especially in the areas of waterborne diseases and implementation of universal vaccination. This however leaves a large section of the population with ESRD vulnerable, and it is up to the various stakeholders, including the medical professions, to innovate and partly alleviate their suffering as a social responsibility.