The number of patients on dialysis has increased by about 50% in the past decade in Belgium. This growth is expected to continue, albeit at a slower pace, due to the ageing of the population and the increased prevalence of hypertension and diabetes, two of the main causes of end-stage kidney disease. The aim of this study was to assess the economic burden (i.e., dialysis procedure; hospitalizations; ambulatory care; medications; transport) to the public healthcare payer of patients undergoing dialysis in Belgium. Records of 130 Belgian patients on dialysis in 2006 were retrospectively reviewed to identify direct medical and non-medical resources used over a year. Official tariffs were used to cost the resources. Considering the prevalence of each dialysis modality in Belgium, the average cost of a dialysis patient was found to be €70,649 per year (haemodialysis: €72,350; peritoneal dialysis: €55,343). The dialysis procedure itself was the main cost driver (66% of all costs) followed by hospitalizations and ambulatory care (16% of all costs each). The dialysis procedure per se was 27% more expensive, while hospital and ambulatory services were respectively 28% and 45% more expensive for haemodialysis than peritoneal dialysis patients. Considering that there were 6,607 patients on dialysis in Belgium (0.06% of the Belgian population) at the end of 2006, it is estimated that the economic burden to the Belgian healthcare system was 467 million Euro or 2.45% of the healthcare budget. This study provides further evidence that home modalities, such as peritoneal dialysis, could help reduce the economic burden of dialysis on the healthcare budget.