ABSTRACT
The number of centers providing regular dialysis varies from 1.5 per million population (pmp) in the United Kingdom to 20.3 pmp in Japan (3). These units are both hospital-based or minimal care (free-standing) units located in metropolitan and nonmetropolitan areas. The exact number of dialysis units in various developing countries is not known. Available data show that the number varies greatly in different countries (Fig. 1). In some countries, like Brazil (3.3 pmp) (4) and Uruguay (9.03 pmp) (5), dialysis facilities are comparable to those available in the developed world, whereas in others, like Algeria (0.8 pmp) (6) and China (0.2 pmp) (7), the facilities are meager. Zimbabwe, with a population of 11 million, has only two dialysis centers. We conducted a survey of dialysis units in India that revealed that there are only about 0.2 dialysis centers pmp (8). About 68% of these centers are in the private sector and are accessible only to upper-income patients. Most of the dialysis centers have only two to four dialysis stations, grossly insufficient for the number of patients needing such facilities. Moreover, a majority of the population of the developing countries lives in remote rural areas where dialysis facilities are not available. As a result, patients and their families have to travel long distances and in many instances have to be relocated, with resultant loss of livelihood.
