Dynamics of Renal Replacement Therapy in Thailand

Abstract Background : Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) is major public health spending in Thailand, which has been changed by policy and disease contributions. Objectives : This study aims to investigate the dynamics of RRT among Thai ESKD patients, and identify factors associated with the transition of the mode of therapy and mortality. Methods : Data were obtained from the national ESKD registry, documenting all RRT events from 2015 to 2019, and the national death registry. Baseline patient characteristics were summarized using descriptive statistics. A Markov model was used to evaluate RRT modality transition rates, while logistic regression identified factors associated with changes in health states. Results : Most patients were female (51.2%) and aged 50–69 years (57.8%) at RRT initiation. RRT use increased steadily, with CAPD being the most common initial modality (67.0%), followed by HD (31.9%) and KT (1.1%). Most had short inter-transit periods of 0–6 months (82.3%). RRT rates were highest in the northeastern region. CAPD had the highest transition rate (46.5%), followed by death (26.4%), HD (26.1%), and KT (1.1%). The probability of remaining on CAPD ranged from 63.6% to 69.6%, and for HD from 76.1% to 79.1%, while KT had the lowest transition. Multivariate analysis showed that younger patients and those who recently initiated RRT had higher transition rates to HD, with a peak in 2017 and the highest rate in Bangkok. In contrast, predictors of mortality followed the opposite pattern: older age and longer duration since RRT initiation were associated with higher mortality, while residents of Bangkok had the lowest mortality rates. Conclusion : During the study period, RRT use in Thailand increased steadily. The CAPD-first policy appears effective, as relatively few patients shifted to HD over time, though KT rates remained low. Despite limited clinical data, geographical disparities were evident, with higher HD use and lower mortality among Bangkok residents. These findings highlight the need for improved planning and implementation of RRT services in Thailand.