Hemodialysis is the most useful renal replacement therapy in the world. However, it remains inaccessible to the majority of patients in developing countries because of its costs. In Madagascar, 95% of patients requiring dialysis don't have an access to do it. That prompted us to search some solutions while prioritizing the effectiveness of the treatment. We initiated the reuse of dialyzers with lines in Hemodialysis since June 2016. Our objectives are to determine its efficiency, to report its side effects, and to compare its cost to single-use dialysis. This is a prospective, observational study in single center. All patients dialyzed incorrectly (less than three times a week) in the Center and who accepted to practice reuse were included. We excluded all infected patients with Hepatitis, HIV, severe infections or under corticotherapy for a long period. In our cohort, 44.76% of the patient accepted to practice reuse. 537 reuses were carried out with 47 dialyzers. Each dialyzer were reused on average 11 times. The average urea before and after reuse were 15.42 and 4.53 mmol / l. The mean Urea Reduction Ratio was 70,6% and the mean Kt/V was 1.4. Any side effects and any death were reported. Concerning the costs, the reuse technique allowed to reduce monthly 57.07% on the total costs of treatment comparing to single-use dialysis. To conclude, reuse of dialyzer seems to offer both cost-effective and efficient results. We conclude that it may be a safe alternative of end-stage renal disease care in Madagascar.