Economics plays the leading role in determining the availability of dialysis in countries throughout the world. The countries with the largest numbers of patients on dialysis are among the richest: the United States, Japan, and Germany. The number of patients per million population treated with dialysis correlates highly with the gross national product per capita. Countries with a per capita gross national product of less than $3,000 per year treat a negligible number of patients with dialysis and transplantation. Approximately three-quarters of the world's population live in these poorer countries.
In parts of the world where dialysis technology and money for healthcare are limited, dialysis is severely rationed. Two sets of criteria have been used to select patients for dialysis. In India, China, Egypt, Libya, Tunisia, Algeria, Morocco, Kenya, and South Africa, money and political influence play an important role in deciding which patients will have access to dialysis and transplantation. In Eastern Europe, ESRD patients with primary renal disease who have a lower mortality and who are more likely to be rehabilitated tend to be selected (Kjellstrand and Dossetor).
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