**1. Introduction**

The epidemiology of infectious endocarditis (IE) has changed over the past five decades, with many contributing factors for the increasing incidence. The survival rate of chronically ill patients with nephropathy and cardiac patients has increased by transplanting or immunosuppressing, which is a consequence of medical advances. All risk factors in certain subgroups of patients are associated with the use of intracardiac or intravascular devices, prosthetic implants or catheters, and immunosuppressive drugs, causing increased health care-related infections. Despite advances in medicine, in-hospital mortality rate of IE remains high with no significant decrease observed since the 1960s [1].

Despite many scientific efforts that have been made to realize the magnitude of this problem in different regions of the world, assessing its incidence is difficult because of the few epidemiological studies that currently exist globally; the incidence of endocarditis may vary from one country to another, between 1.5 and 11.6 per 100,000 inhabitants. Apart from its incidence, it is recognizing that this is a condition that involves high morbidity and mortality [2].

Infective endocarditis (IE) in patients with end-stage renal disease (ESRD) is a problem that continues *in crescendo* worldwide, with high morbidity and mortality, but in developing countries, the problem is more alarming due to various factors such as underdevelopment, economic inequality, and limitations in health care systems. The treatment has not changed in recent decades and instead epidemiological characteristics show very specific changes that vary from the developed countries to developing countries [3, 4].

Some authors have proposed modifications in the IE classification to address hemodialysis (HD) patients in a different category, because they represent a crescent population of IE patients and diagnostic and treatment challenge for clinicians and surgeons [5].

This chapter highlights some identified differences as well as some regional differences between developed and developing countries, and provides strategies to reduce IE in HD patients, which can be performed in any health care facility.
