An article in the journal Nature Medicine discusses a 2022 policy change in Thailand that allowed patients to choose between peritoneal dialysis and hemodialysis.[1] According to the multidisciplinary commission, this policy change had serious unintended consequences for the Thai health system.[1] The commission found that interacting factors in the dialysis system were overlooked in policymaking.[1] The article emphasizes that future dialysis policies need to integrate more diverse evidence and stakeholder views.[1] A key requirement is prioritizing quality of care and ethics in dialysis delivery.[1] At the same time, the principles of equality and sustainability of the health system must be balanced.[1]