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with CVD in RRT facilities. More patients with kidney disease die before they get to the point at which they need treatment for renal failure, because early kidney disease is a major marker for CVD and reinfarction, congestive heart failure, and stroke. In middle-income countries such as Thailand and Turkey and in middle-income countries in Latin America (Zatz, Romão, and Noronha 2003), extensive dialysis facilities are available, as they are in some low-income countries. For example, in 2003, Pakistan had 110 centers with 2,400 patients on hemodialysis; India had 100 centers with 6,000 patients mostly on hemodialysis; and China had 75,000 patients on dialysis.Those figures show that needs and markets for dialysis are expanding. However, in poorer countries, such as Nicaragua and Tanzania, options for RRT are limited because of the lack of equipment, trained staff, and costly consumables. In addition, many low-income countries lack health insurance to defray treatment expenditures, keeping dialysis out of reach. In such countries—for example, Nigeria—dialysis directed at preparation for renal transplantation is the best policy. Recent findings concerning primary prevention through lifestyle changes and secondary prevention by means of pharmaceutical treatment should eventually reduce, but not eliminate, the burden of ESRD. The acknowledgment by the World Bank and the World Health Organization that chronic conditions, particularly those resulting from diabetes and hypertension, will increase to become a leading cause of death by 2028 has intensified the need for prevention and RRT programs. The need to increase awareness, launch targeted screening and intervention studies, provide training for staff, maintain education for physicians in kidney and urological disease, and assist centers for RRT is urgent. Developed nations have well-established nephrology and urology centers attached to academic medical institutions and regional public and private secondary and tertiary referral hospitals. They have training programs to meet national requirements for health professionals—including renal physicians, primary care physicians, and nurses—specializing in kidney and urological disorders. Their centers incorporate the results of up-to-date research developments pertaining to kidney disease and clinical applications of the latest advances in care and technology. Numerous publications arise from academic endeavors, and a close association exists between health care delivery and pharmaceutical industries. Each country and region has societies of nephrology and urology for adults and children. Middle-income countries may have both public academic centers and private hospitals that offer specialized equipment, 702 | Disease Control Priorities in Developing Countries | John Dirks, Giuseppe Remuzzi, Susan Horton, and others such as lithotripters and imaging technology, and dialysis and transplant programs.