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Hemodialysis adequacy is a complex concept that encompasses largely the dialysis dose appraisal based on monthly blood-based urea Kt/V measurement. Renal replacement therapies should provide an efficient way to clear adequately larger molecular weight solutes, to restore normal salt, electrolytes and fluid balance, to correct salt-dependent hypertension, to improve hemodynamic stability and to reduce bio-incompatibility of the hemodialysis system. Targeting such ambitious objective is obviously under the clinical supervision and judgment of nephrologists and care givers. Monitoring and achievement of these targets as a part of a continuous quality improvement process is necessary to attain dialysis adequacy goals. This review aims to provide an overview of available online hemodialysis technologies, their current applications in clinic, and the potential for future developments in improving care of chronic kidney disease patients. In order to facilitate understanding of readers we choose to classify online monitoring devices based on their clinical action.