**2. Epidemiology**

The precise incidence of IE is difficult to ascertain because case definition has varied over time between authors and clinical centers [6].

IE varies according to the region. Limited data suggest that the characteristics of IE in lowincome countries differ from those in industrialized countries. It is estimated that over 33,700 rheumatic heart disease (RHD)-related IE cases arise each year in developing countries and that this leads to over 8400 deaths [7].

Many literature reports and a few retrospective series have been presented on infective endocarditis in the hemodialysis population. The true incidence of IE in HD patients is, at best, an underestimate in retrospective studies. It is reported that it occurs in 6% of HD patients. The incidence of IE in HD patients is estimated to be 308/100,000 patient-years, which is 50- to 180-fold higher than 1.7–6.2 cases per 100,000 patient-years reported for the general population [8].

In a recent retrospective cohort study in Taiwan undertaken to determine IE and the mortality risk factors among HD patients, the prevalence of IE of 6.9% was reported. The overall mortality in HD patients with IE was 60.0% [9]. The mortality rate is also higher (30–77.8%) in HD patients than in IE patients in the general population (17%) [4]. There is a high postoperative mortality 11–80% in HD patients which requires surgical intervention for IE [10].
