Nephrology (Carlton). 2026 Mar;31(3):e70191. doi: 10.1111/nep.70191.
ABSTRACT
AIM: End-stage kidney failure (ESKF) represents a major and expanding public health challenge globally and in Thailand, where patients receiving maintenance haemodialysis continue to experience high morbidity and mortality. The Thailand Renal Replacement Therapy (TRT) Registry offers a comprehensive national database to evaluate dialysis practices, patient characteristics and long-term outcomes.
METHODS: We conducted a nationwide retrospective cohort study using TRT Registry data from January 2018 to December 2023. A total of 60 053 adult patients undergoing maintenance haemodialysis at 1106 dialysis centres were included. Survival outcomes were assessed using Kaplan-Meier methods, and factors associated with all-cause mortality were identified using multivariable Cox proportional hazards models. Mortality data were ascertained through linkage with national death records.
RESULTS: Diabetic nephropathy and hypertensive nephropathy accounted for more than 80% of ESKF etiologies. The estimated 1-, 3- and 5-year survival rates were 95.0%, 84.6% and 76.6%, respectively. Five-year survival varied significantly by primary cause of ESKF, being lowest in diabetic nephropathy (71.6%, 95% CI 70.7-72.4) and highest in glomerulonephritis (85.4%, 95% CI 82.8-87.7). Patients receiving twice-weekly haemodialysis had lower 5-year survival than those receiving thrice-weekly treatment (74.4% vs. 77.7%). Cardiovascular disease (34.1%), infection (20.8%) and cerebrovascular disease (8.0%) were the leading causes of death. Independent predictors of mortality included advanced age, male sex, diabetes-related kidney failure, use of permanent catheters, twice-weekly dialysis, haemoglobin < 10 g/dL, serum sodium < 135 mEq/L, potassium < 3.5 mEq/L, bicarbonate < 22 mEq/L, phosphate > 4.5 mg/dL, albumin < 3.5 g/dL, intact parathyroid hormone (PTH) < 130 pg/mL, transferrin saturation < 30% or > 40%, URR < 65% and nPCR < 1.2 g/kg/day.
CONCLUSION: Although early survival among Thai haemodialysis patients is relatively favourable, long-term mortality remains substantial. Targeting modifiable clinical risk factors, optimising dialysis adequacy and vascular access and addressing socioeconomic disparities are critical to improving national outcomes.
PMID:41830341 | DOI:10.1111/nep.70191