Nature Medicine Commission on dialysis policy in low- and middle-income countries
7
Issued Date
2026-01-01
Resource Type
ISSN
10788956
eISSN
1546170X
Scopus ID
2-s2.0-105028227035
Pubmed ID
41566046
Journal Title
Nature Medicine
Volume
32
Issue
1
Start Page
58
End Page
71
Rights Holder(s)
SCOPUS
Bibliographic Citation
Nature Medicine Vol.32 No.1 (2026) , 58-71
Suggested Citation
Teerawattananon Y., Chavarina K.K., Phannajit J., Sutawong J., Yongphiphatwong N., Chawla N., Botwright S., Chuanchaiyakul T., Anothaisintawee T., Arogundade F., Ashuntantang G., Thammatacharee J., Sola L., Chuengsaman P., Chunharas S., Wibulpolprasert S., Tang S.C.W., Kanjanabuch T., Luyckx V., Ophascharoensuk V., Isaranuwatchai W., Jha V., Praditpornsilpa K., Tungsanga K., Teerawattananon Y., Limsawart W., Thitjuea S., Boonkaew S., Khamkom S., Tatiyanupanwong S., Ngam-prukwanit R., Supapol P., Kiatkrissada N., Thamcharoen N., Gandhi N., Chareonrungruengchai K., Khositrangsikun K., Piyawong J., Aryani H., Butani D.H., Pandejpong D., Sriprach S., Pichaiwong W., Dokkaew T., Sirilak S., Sitthitham N., Aiyasanon N., Kiattisunthorn K., Tabongkaraksa C., Dabak S.V., Boonma C. Nature Medicine Commission on dialysis policy in low- and middle-income countries. Nature Medicine Vol.32 No.1 (2026) , 58-71. 71. doi:10.1038/s41591-025-04084-w Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114818
Title
Nature Medicine Commission on dialysis policy in low- and middle-income countries
Author(s)
Teerawattananon Y.
Chavarina K.K.
Phannajit J.
Sutawong J.
Yongphiphatwong N.
Chawla N.
Botwright S.
Chuanchaiyakul T.
Anothaisintawee T.
Arogundade F.
Ashuntantang G.
Thammatacharee J.
Sola L.
Chuengsaman P.
Chunharas S.
Wibulpolprasert S.
Tang S.C.W.
Kanjanabuch T.
Luyckx V.
Ophascharoensuk V.
Isaranuwatchai W.
Jha V.
Praditpornsilpa K.
Tungsanga K.
Teerawattananon Y.
Limsawart W.
Thitjuea S.
Boonkaew S.
Khamkom S.
Tatiyanupanwong S.
Ngam-prukwanit R.
Supapol P.
Kiatkrissada N.
Thamcharoen N.
Gandhi N.
Chareonrungruengchai K.
Khositrangsikun K.
Piyawong J.
Aryani H.
Butani D.H.
Pandejpong D.
Sriprach S.
Pichaiwong W.
Dokkaew T.
Sirilak S.
Sitthitham N.
Aiyasanon N.
Kiattisunthorn K.
Tabongkaraksa C.
Dabak S.V.
Boonma C.
Chavarina K.K.
Phannajit J.
Sutawong J.
Yongphiphatwong N.
Chawla N.
Botwright S.
Chuanchaiyakul T.
Anothaisintawee T.
Arogundade F.
Ashuntantang G.
Thammatacharee J.
Sola L.
Chuengsaman P.
Chunharas S.
Wibulpolprasert S.
Tang S.C.W.
Kanjanabuch T.
Luyckx V.
Ophascharoensuk V.
Isaranuwatchai W.
Jha V.
Praditpornsilpa K.
Tungsanga K.
Teerawattananon Y.
Limsawart W.
Thitjuea S.
Boonkaew S.
Khamkom S.
Tatiyanupanwong S.
Ngam-prukwanit R.
Supapol P.
Kiatkrissada N.
Thamcharoen N.
Gandhi N.
Chareonrungruengchai K.
Khositrangsikun K.
Piyawong J.
Aryani H.
Butani D.H.
Pandejpong D.
Sriprach S.
Pichaiwong W.
Dokkaew T.
Sirilak S.
Sitthitham N.
Aiyasanon N.
Kiattisunthorn K.
Tabongkaraksa C.
Dabak S.V.
Boonma C.
Author's Affiliation
Harvard Medical School
National University of Singapore
The University of Hong Kong
University of Cape Town
University of Strathclyde
Chulalongkorn University
Imperial College Faculty of Medicine
Duke-NUS Medical School
Siriraj Hospital
Obafemi Awolowo University
Université de Yaoundé I
Institute of Health Policy, Management and Evaluation
George Institute for Global Health
Faculty of Medicine, Chiang Mai University
Kinderspital Zürich
Ramathibodi Hospital
King Chulalongkorn Memorial Hospital
Silpakorn University
Faculty of Medicine, Chulalongkorn University
Thailand Ministry of Public Health
Rajavithi Hospital
Prasanna School of Public Health
International Health Policy Program, Thailand
Thailand Development Research Institute
National Health Security Office
Chaiyapoom Hospital
Health Intervention and Technology Assessment Program
Maharat Nakhon Si Thammarat Hospital
The Medical Association of Thailand
National Health Foundation, Thailand
Banphaeo Hospital
Thailand Health Systems Research Institute
CASMU-IAMPP
Bhumirajanakarindra Kidney Institute Hospital
Kantharalak Hospital
Bangkhla Hospital
Pinkanakorn Development Agency
Thai Kidney Friends Association
National University of Singapore
The University of Hong Kong
University of Cape Town
University of Strathclyde
Chulalongkorn University
Imperial College Faculty of Medicine
Duke-NUS Medical School
Siriraj Hospital
Obafemi Awolowo University
Université de Yaoundé I
Institute of Health Policy, Management and Evaluation
George Institute for Global Health
Faculty of Medicine, Chiang Mai University
Kinderspital Zürich
Ramathibodi Hospital
King Chulalongkorn Memorial Hospital
Silpakorn University
Faculty of Medicine, Chulalongkorn University
Thailand Ministry of Public Health
Rajavithi Hospital
Prasanna School of Public Health
International Health Policy Program, Thailand
Thailand Development Research Institute
National Health Security Office
Chaiyapoom Hospital
Health Intervention and Technology Assessment Program
Maharat Nakhon Si Thammarat Hospital
The Medical Association of Thailand
National Health Foundation, Thailand
Banphaeo Hospital
Thailand Health Systems Research Institute
CASMU-IAMPP
Bhumirajanakarindra Kidney Institute Hospital
Kantharalak Hospital
Bangkhla Hospital
Pinkanakorn Development Agency
Thai Kidney Friends Association
Corresponding Author(s)
Other Contributor(s)
Abstract
The global demand for kidney replacement therapy (KRT) continues to increase, yet access remains limited in many low- and middle-income countries. Thailand has been recognized for integrating a sustainable KRT delivery model into its Universal Health Coverage scheme through a peritoneal dialysis–first (‘PD-First’) policy adopted in 2008. In 2022, the policy was revised to allow individuals to choose between hemodialysis or peritoneal dialysis as their first-line treatment. The intention was to improve patient choice and avoid high out-of-pocket costs, but the policy produced unintended consequences for the health system and patients. A Commission was convened to first assess the impact of the policy change and provide policy recommendations to the Thai government and, second, provide lessons for countries working to expand equitable access to KRT within national universal health coverage frameworks. Drawing on empirical data, the Commission—composed of Thai and international multidisciplinary experts—employed a structured deliberative process to inform policy interventions. The process and findings underscore the importance of participatory policymaking, underpinned by evidence and a systematic process, and monitoring and evaluation in managing complex policy transitions.