Kidney Week

Abstract: SA-PO0549

Gastrointestinal Dialysis in Patients with Advanced CKD Who Decline Kidney Replacement Therapy

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Corona Alejo, Josue Michel, Hospital General de Occidente, Guadalajara, Jal., Mexico

Josue Michel Corona Alejo

• Aranda, Andres, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico

Andres Aranda, MD

• Pazarin-Villaseñor, Leonardo, Hospital General Regional No 46, Guadalajara, Jal., Mexico

Leonardo Pazarin-Villaseñor, MD

• Ruiz Fabian, Linda Giovanna, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico

Linda Giovanna Ruiz Fabian, MD

• Garcia, Hector Enrique, Hospital General de Occidente, Guadalajara, Jal., Mexico

Hector Enrique Garcia, MBBS, MEd

• Padilla, Ignacio Diaz, TrasplantateMx, Guadalajara, Jalisco, Mexico

Ignacio Diaz Padilla, MD

• Van Dyck Diaz, Rodolfo Candelario, Colegio Jalisciense de Nefrologia, Guadalajara, Jalisco, Mexico

Rodolfo Candelario Van Dyck Diaz, MD

Background

Advanced CKD patients declining renal replacement therapy (RRT) have limited options. Gastrointestinal dialysis (GID) solution, an oral cathartic, osmotic, and electrolyte salt mixture used to delay RRT, is a proposed conservative strategy with limited real-world evidence. We evaluated its effectiveness, safety, and cost.

Methods

Retrospective cohort of 38 stage 5 CKD patients with uremia who declined RRT and received in home GID every 7 or 14 days. Baseline data were collected, and patients were followed for 36 months.
The primary outcome was a composite of improvement in uremic syndrome at last follow-up and dialysis-free survival.
Secondary outcomes included biochemical changes, mortality, treatment discontinuation, safety, and cost versus hemodialysis (HD).

Results

At 36 months, 36/38 patients (94.7%) remained free of RRT and uremic symptoms. Biochemical parameters showed stable K+ levels and a mild increase in serum HCO3-, consistent with sustained metabolic stabilization. No mortality or major treatment-related adverse events were observed. Estimated cumulative 36-month costs for GID were $4,994 for dosing every 14 days, $9,987 every 7 days, versus $40,856 for in-center HD 3 times weekly. Importantly, these figures for in-center HD do not include additional healthcare system costs.

Conclusion

GID appears feasible and well tolerated in advanced CKD patients refusing RRT. It was associated with metabolic stability, symptom control, prolonged dialysis-free survival, and lower treatment-related costs. These findings are hypothesis-generating and support further prospective evaluation.