Kidney Week

Abstract: FR-PO1074

Urgent Start of Peritoneal Dialysis vs. Hemodialysis in Kidney Failure in Severe Metabolic Acidosis: A Prospective Study

Session Information

• Top Trainee Posters - 2
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 01:42 PM - 01:48 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Chavez, Jonathan, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Jonathan Chavez, MD, PhD

• Medina, Ramon, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Ramon Medina, MD

• Alcantar Vallin, Maria de la Luz, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Maria de la Luz Alcantar Vallin, MD

• Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Navarro Blackaller, MD

• Martínez Gallardo González, Alejandro, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Alejandro Martínez Gallardo González

• Gómez, Juan Alberto, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Juan Alberto Gómez, MD

• Renoirte, Karina, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Karina Renoirte, MD

• Garcia-Garcia, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Garcia-Garcia, MD, FASN

Background

Severe metabolic acidosis (pH <7.25 and serum bicarbonate <20 mEq/L) is a life-threatening complication of kidney failure and a frequent indication for urgent initiation of kidney replacement therapy (KRT). Although hemodialysis (HD) is traditionally considered more effective for rapid acid–base correction, evidence directly comparing its efficacy with urgent-start peritoneal dialysis (PD) is limited.

Methods

We conducted a prospective cohort study including 68 consecutive dialysis-naïve patients with kidney failure and severe metabolic acidosis requiring urgent KRT at a tertiary referral center (31 HD, 37 PD). Treatment modality assignment was based on the attending nephrologist's clinical judgment and immediate resource availability. The primary outcome was the longitudinal trajectory of pH and serum bicarbonate from admission to 48 hours and discharge, analyzed using mixed-effects regression models. To address confounding by indication, inverse probability of treatment weighting (IPTW) was applied. Secondary outcomes included in-hospital mortality and technique survival

Results

Both modalities were associated with significant improvement in acid–base parameters over time (p <0.001 for time effect). Baseline serum bicarbonate levels were 7.6 mEq/L in the HD group and 12.1 mEq/L in the PD group (p = 0.18). By the end of hospitalization, bicarbonate increased to 16.6 mEq/L in HD and 18.2 mEq/L in PD. No significant interaction between dialysis modality and time was observed for pH or bicarbonate trajectories in either unadjusted or IPTW-adjusted models (interaction p >0.05), indicating parallel correction patterns. The absolute magnitude of bicarbonate change was also comparable between groups (Δ +9.0 vs. +6.1 mEq/L, p = 0.12). In-hospital mortality was similar (HD 39% vs. PD 42%; adjusted OR 1.56, 95% CI 0.52–4.68), as was technique survival.

Conclusion

In patients with kidney failure in severe metabolic acidosis requiring urgent KRT, PD demonstrated acid–base correction and short-term clinical outcomes comparable to HD. These findings support urgent-start PD as a safe and metabolically effective alternative to HD in this high-risk setting.