Fish protection is a priority in regions with ongoing and planned development of hydropower production, like the Mekong River system. The evaluation of the effects of turbine passage on the survival of migratory fish is a primary task for informing hydropower plant operators and authorities about the environmental performance of plant operations. The present work characterizes low pressures and collision rates through the Kaplan-type runners of the Xayaburi hydropower station. Both an experimental method based on the deployment of Sensor Fish and a numerical strategy based on flow and passage simulations were implemented on the analysis of two release elevations at one operating point. Nadir pressures and pressure drops through the runner were very sensitive to release elevation, but collision rates on the runner were not. The latter showed a frequency of occurrence of 8.2–9.3%. Measured magnitudes validated the corresponding simulation outcomes in regard to the averaged magnitudes as well as to the variability. Central to this study is that simulations were conducted based on current industry practices for designing turbines. Therefore, the reported agreement helps turbine engineers gain certainty about the prediction power of flow and trajectory simulations for fish passage assessments. This can accelerate the development of environmentally enhanced technology with minimum impact on natural resources.