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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
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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.
How does a globally acclaimed dialysis program collapse into crisis, causing 5,500 excess deaths and a USD 118 million deficit? Thailand's "PD-First" policy (2008-2021) achieved international recognition for 30% PD utilization—three times the global average—with outcomes comparable to high-income countries. Implemented as an LMIC, this policy provided free dialysis under Universal Health Coverage—covering 75% of the population—but restricted modality choice. The 2022 "Free-Choice" transition aimed to enhance patient autonomy but overwhelmed the system within 2.5 years. This "Success Paradox"—where the success of a restrictive policy masks system vulnerabilities that surface during liberalization—offers critical lessons for health systems expanding dialysis access.
A narrative synthesis analyzed three policy periods: "PD-First" (2008-2022), "Free-Choice" (2022-2025), and 2025 policy (post-April 2025). We searched PubMed/Scopus using the terms ("Thailand" AND ("dialysis" OR "renal replacement therapy" OR "PD-First") AND "policy"). Data sources included the Thai Renal Replacement Therapy Registry, the CKD Disease Management Information System, and a systematic evidence-based policy analysis by a multidisciplinary Commission convened by the National Health Security Office, including researchers and Thai and international experts.
Following the 2022 "Free-Choice" policy, clinical indicators showed rapid deterioration. The unplanned dialysis rate (initiation via non-tunneled catheter) increased from 44% to 59%; 90-day mortality among incident dialysis patients rose from 9% to 13%; and PD uptake among new patients dropped to 11%. Total kidney replacement therapy (KRT) expenditure increased 78%, from 9,000 million Baht (USD 273 million) to 16,000 million Baht (USD 485 million) between 2020-2024, with a deficit of 4,083 million Baht (USD 124 million) by September 2025. Systematic analysis revealed that the restrictive "PD-First" policy had masked structural gaps in quality monitoring infrastructure, vascular surgery capacity, and payment structures that favored HD. In April 2025, the 2025 policy was implemented, incorporating Pre-authorization clinical review and infrastructure development. Indicators improved rapidly: 90-day mortality declined to 7% (16% below "PD-First" baseline), unplanned dialysis dropped to 47%, PD uptake increased to 58%, and the budget began to stabilize.
Thailand's experience demonstrates that restrictive policies can mask systemic weaknesses that surface during policy transitions. Key lessons: conduct systematic pre-policy assessments of infrastructure, payment structures, and workforce capacity; policy changes require proactive regulatory oversight—systems do not adapt automatically; and sustained stakeholder engagement prevents disconnect between policy and practice. Based on these insights, we propose an early-warning framework for countries planning major dialysis policy changes: monthly monitoring of unplanned dialysis rate, vascular access quality, and 90-day mortality. These process indicators provide earlier alerts than aggregate outcomes and are applicable across policy models. For LMICs expanding dialysis access, this framework offers a practical, evidence-based tool for policy evaluation—though prospective validation across diverse settings remains essential.
