**9. Conclusion**

Here we have addressed the different protocols and outcomes among developed countries due to ESRD patients' population, economy and health care differences in each country. This means that the recommendations of different associations and foundations have not been completely followed up by all HD systems even in developed countries.

So to answer the question: what is the problem in developing countries? There are many answers.

Late ESRD diagnosis or any risk factors can end in ESRD, due to not having a routine checkup in primary health care service.

Incomplete protocols, as already stated, are common in developing countries, making changes to these protocols based on "saving" money only or to provide more medical care to a large number of patients, giving them suboptimal care due to inadequate time for each patient. Because health care providers in developing countries have too many patients, it is not possible to offer optimal service quality.

Unavailability of the adequate equipment.

Not having the right timing between dialysis treatments, and especially between diagnosis and definitive treatment with kidney transplant.

Long waiting lists due to fewer transplant centers for kidney transplantation.

In developing countries, most of the patients are uneducated, or they do not have accurate information about their diseases or their HD route.

In the recommendations given in this chapter, after analyzing the literature and the guidelines for preventing IE in ESRD patients, we summarized the prevention strategies and sought to apply them in any developing country for having less incidence of IE in ESRD patients.

Being part of a health care institution in a developing country, you have to learn how to manage this and other related difficulties. The only method to give a solution to this problem is by analyzing the procedure of other hospitals, either from your region or from other countries, which will give you good arguments for requesting anything missing in your program to provide quality care to their patients. In other words, you have to demonstrate that is cost-effective and it will benefit the patient and the hospital.
