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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
A fundamental tension in universal health coverage (UHC) systems is balancing patient autonomy with the sustainable stewardship of finite resources. Dialysis care exemplifies this challenge, where high-cost haemodialysis (HD) often competes with more cost-effective peritoneal dialysis (PD). We leveraged Thailand's rapid, sequential dialysis policy reversals—from a "PD-First" model (Policy 1) to unrestricted patient choice (Policy 2), and back to a "PD-First with Pre-Authorisation (PA)" gatekeeping model (Policy 3)—as a natural experiment to inform this global debate.
We conducted a retrospective analysis using monthly national claims and laboratory data from January 2020 to September 2025, including all chronic dialysis and kidney transplant patients under Thailand’s Universal Health Coverage (N = 148,279). The linked databases captured dialysis incidence, prevalence, 90-day mortality, vascular access, unplanned dialysis (with temporary catheter), hospitalisations, costs, and survival. Laboratory records identified 154,400 CKD stage 5 patients (eGFR <15 ml/min/1.73 m² ≥ 3 months) not yet on dialysis and monitored pre-dialysis deaths as indicators of access delay under the pre-authorisation (PA) system. Segmented interrupted time-series models with negative-binomial distribution estimated level and slope changes after each policy shift.
The shift to unrestricted patient choice (Policy 2) was associated with a rapid doubling of HD incidence, a sharp decline in PD uptake (66% to 15% among new cases), and a concomitant rise in unplanned dialysis starts (44% to 59%) and early mortality (8.7% to 13.1%). Reintroducing PD First with pre-authorisation (Policy 3) rapidly rebalanced the modality mix (PD uptake at day-90 rebounded to 44%), reduced unplanned starts to 47%, and lowered 90-day HD mortality to 7.3%. Crucially, the gatekeeping process did not restrict necessary care; 96% of pre-authorisation requests were approved within 15 days, primarily to manage premature dialysis starts, and pre-dialysis mortality remained stable.
Thailand's experience provides critical evidence for global health policy. Unrestricted patient choice in a fee-for-service environment can lead to rapid, costly expansion of in-centre HD and worse early outcomes, potentially due to unprepared systems. A managed care approach with pre-authorisation can effectively steer systems towards a more sustainable and higher-quality mix of modalities, including PD and conservative care, without denying necessary dialysis. These findings offer a blueprint for other UHC nations seeking to optimize dialysis outcomes and financial sustainability.
