2024 Annual Report of the Thailand Renal Replacement Therapy (TRT) Registry – Executive Summary

The 2024 Thailand Renal Replacement Therapy (TRT) Registry Annual Report examines national trends in incidence, prevalence, practice patterns, and outcomes to inform health policy and system planning. In 2024, the incidence of renal replacement therapy (RRT) reached a historic high of 515 per million population (33,976 new cases), largely reflecting the expansion of hemodialysis (HD) following the implementation of the 2022 “free-choice” dialysis policy. Peritoneal dialysis (PD) initiation declined markedly, while kidney transplantation remained limited. RRT prevalence more than doubled from 2016 to 2024, exceeding 2,600 per million population, with HD accounting for most of the increase. Diabetes (32.7%) and hypertension (32.2%) were the leading causes of end-stage kidney disease. The dialysis population was predominantly older (mean age 62.6 years) and had relatively low educational attainment. Important care gaps were identified, including high catheter use at HD initiation, frequent twice-weekly dialysis, suboptimal anemia control, prevalent mineral and bone disorders, and insufficient preventive care. Between 2017 and 2024, cumulative mortality reached 39.2% (9.5 deaths per 100 patient-years), with higher mortality in PD than HD patients. Cardiovascular disease and infections were the leading causes of death. One-year survival was 95.4%, declining to 61.9% over five years. Despite expanded RRT access under universal coverage, improving long-term outcomes and system sustainability will require strengthened chronic kidney disease prevention, optimized dialysis quality, equitable financing, expanded transplantation, and continued investment in high-quality registry data.