(2.04 PMP), Mongolia (2.00 PMP), and South Korea (1.12 PMP) reported significantly lower densities. China (1.46 PMP) reported the second lowest density in the region, yet it reported the highest absolute number of nephrology trainees (n ¼ 1667). In the South Asia ISN region, all countries reported trainee densities below the global average. India (0.24 PMP) and Nepal (0.25 PMP) reported the lowest while Pakistan (1.26 PMP) and Bangladesh (0.71 PMP) reported the highest densities. In the Western Europe ISN region, all countries reported trainee densities above the global average, except Israel (1.62 PMP). Netherlands (2.51 PMP), Belgium (2.65 PMP), and France (5.26 PMP) reported the lowest trainee densities in the region, while Norway (9.60 PMP), Greece (9.28 PMP), and Spain (7.23 PMP) reported the highest. Availability of nephrology training programs. Overall, 79% of countries reported the availability of a nephrology training program. Nearly all (97%) of high-income countries and 80% of upper-middle– and lower-middle–income countries reported having a program. Less than one-half (41%) of lowincome countries reported having a program (Figure 2a). Across the 10 ISN regions, all countries (100%) in 5 ISN regions—North America, North and East Asia, NIS and Russia, South Asia, and Western Europe—reported availability of training programs. In the other 5 ISN regions, the numbers of countries reporting training programs varied: Eastern and Central Europe, 94%; Latin America, 88%; Middle East, 77%; OSEA, 77%; and Africa, 52% (Figure 2a). Structure and duration of nephrology training programs. The structure of nephrology training programs varied across countries. Overall, nephrology as a subspecialty following general internal medicine was the most reported training structure (56%). The next most reported structure was a mixed system of subspecialty and solo training for nephrology trainee depending on the region and/or training center (27%). Few countries reported solo training alone (9%) or other training arrangements (7%). Overall, low-income countries reported training structures that were either subspecialty following general internal medicine (86%) or solo training (14%). Within the 3 other income groups, disribution across the training structure options showed minimum variation; there were similar percentage rates of countries in each income group reporting each of the 4 different training structure options (Figure 2b). Nephrology as a subspecialty following general internal medicine was the most reported training structure across all ISN regions except NIS and Russia (33%), South Asia (40%), and North and East Asia (50%). Solo training was reported in only 4 ISN regions: Africa, 24%; Eastern and Central Europe, 19%; Latin America, 7%; and NIS and Russia, 17%. A mixed system was reported across all regions except North America, where all countries (100%) in the region reported nephrology training as a subspecialty. Other training arrangements were reported in 4 ISN regions: Africa, 6%; Eastern and Central Europe, 25%; Middle East, 10%; and Western Europe, 10% (Figure 2b). Of the countries (79%) that had a nephrology training program, 2% had a less than 2-year program, 86% had a program between 2 and 4 years, and 11% had a program of more than 4 years. Across income groups, the majority of programs were 2 to 4 years. All (n ¼ 6) training programs offered in low-income countries were of this duration. Of the 11 countries that offered programs of more than 4 years, 55% were high-income, 18% were lower-middle–income, and 18% were upper-middle–income countries. Of these, 9% had a program of more than 4 years (Figure 2c). Overall, most countries in the 10 ISN regions had training programs between 2 and 4 years. Programs of more than 4 years were reported in only 4 regions: Africa, 18%; Eastern and Central Europe, 25%; Latin America, 14%; and Western Europe, 20%. Programs of less than 2 years were reported in only 2 regions: NIS and Russia (17%) and North and East Asia (17%) (Figure 2c). Shortages in health care providers in nephrology workforce. A shortage in nearly all health care provider categories essential to nephrology care was identified across all ISN regions and World Bank income groups (Table 1). Overall, the majority of countries reported a shortage in renal pathologists (86%) and vascular access coordinators (81%). Shortages were also reported by a majority of countries in the following provider categories: dietitians (78%), transplant coordinators (69%), dialysis nurses (69%), counselors and/or psychologists (67%), social workers (62%), nurse practitioners (NPs) (60%), and dialysis technicians (60%). Shortages of laboratory technicians, primary care physicians, and pharmacists were reported by less than 35% of countries. Notably, nearly three-quarters (74%) of countries reported a shortage of nephrologists (Table 1). Low-income countries reported renal pathologists and dietitians as the provider categories with the highest shortages (100%). Lower-middle–income countries reported renal pathologists and transplant coordinators as the provider categories with the highest shortages, with 94% and 91%, respectively. Upper-middle–income countries reported renal pathologists (87%), vascular access coordinators (87%), and nephrologists (84%) as the categories with the highest