Incidence of peritoneal dialysis transfer to hemodialysis after the free-choice dialysis policy in Thailand; A tertiary center experience

Thailand has changed its kidney replacement therapy policy in the universal coverage scheme from peritoneal dialysis (PD)-first to free-choice dialysis in February 2022. We aim to compare the incidence rate (IR) of permanent PD transfer to hemodialysis (HD) before and after the national policy change. The records of PD persons in a tertiary hospital in Thailand from February 2020 to January 2023 were reviewed. The time on therapy (TOT) per person-year, the number of PD transfer to HD during the study period were investigated. The incidence of permanent PD transfer to HD was calculated as IR per 100-person-years and the incidence rate ratio (IRR) with a 95% confidence interval (CI) before and after the policy change was analyzed. The IR of PD transfer to HD was 4.31 (95% CI 3.32 to 5.51) per 100 person-years in the PD-first era (TOT of 1483 person-years) and increased to 10.89 (95%CI 8.5–13.74) per 100-person-years (TOT of 652 person-years) after the change to the free-choice dialysis era. The IRR of PD transfer to HD after the change to the free-choice dialysis era significantly increased to 2.52 (95%CI 1.77–3.59, p < 0.001) compared with the PD-first era. The most common reason for PD transfer to HD in the free-choice dialysis era was peritonitis. The cause of transfer to HD by patient preference was only 12.6%. After the change to the free-choice dialysis policy, the IRR of PD transfer to HD significantly increased immediately. The most common cause of PD transfer to HD was peritonitis, not patient preference.