Nature Medicine, Published online: 21 January 2026; doi:10.1038/s41591-025-04144-1
An abrupt policy change in 2022 — allowing patients to choose between peritoneal dialysis or hemodialysis — created severe unintended consequences for the Thai health system. A multidisciplinary commission found that interacting factors in the system were overlooked and that future dialysis policies must integrate more-diverse evidence and stakeholder views, prioritizing care quality and ethics while balancing equity and sustainability.
