Urgent Start of Peritoneal Dialysis Versus Hemodialysis in Kidney Failure in Severe Metabolic Acidosis: A Prospective Study
In brief
Urgent peritoneal dialysis matched hemodialysis for acidosis correction in 68 patients
In this prospective cohort, blood acidity improved similarly over time with urgent-start peritoneal dialysis and hemodialysis; bicarbonate rose by 6.1 and 9.0 mEq/L, respectively, and in-hospital mortality was 42% versus 39%. Modality was chosen by clinicians, not assigned, and the 68-patient study cannot establish equivalence, but it supports peritoneal dialysis as an alternative when urgent treatment is needed.
- Journal
- Kidney360 (Q1)
- Published
- 9 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Eduardo Mendoza-Gaitán, Jose J Zaragoza, Jeffrey Perl, Karla Y Vargas-Langarica, Jarumi A Tanaka-Gutiérrez, Alma I Martínez-Aguilar, et al.
- PMID
- 42853619
- DOI
- 10.34067/KID.0000001377
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 10 October 2026): Urgent‑start PD vs HD trial, directly informs dialysis modality choice
Abstract
BACKGROUND: Severe metabolic acidosis is a life-threatening complication of kidney failure and a common indication for urgent KRT. Although hemodialysis (HD) is traditionally considered the preferred modality for rapid acid-base correction, comparative evidence with urgent-start peritoneal dialysis (PD) remains 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 (HD n=31; PD n=37). Modality selection was based on nephrologist clinical judgment and resource availability. The primary outcome was the trajectory of pH and serum bicarbonate from admission to 48 hours and discharge, analyzed using mixed-effects regression models with inverse probability of treatment weighting (IPTW). Secondary outcomes included in-hospital mortality and technique survival. RESULTS: Both modalities associated with improvement in acid-base parameters over time (p<0.001). Baseline bicarbonate levels were 7.6 mEq/L in HD and 12.1 mEq/L in PD (p=0.18), increasing to 16.6 and 18.2 mEq/L at discharge, respectively. No significant interaction between modality and time was observed for pH or bicarbonate trajectories in unadjusted or IPTW-adjusted analyses (interaction p>0.05). The magnitude of bicarbonate change was comparable between groups (Δ +9.0 vs. +6.1 mEq/L, p=0.12). In-hospital mortality (39% vs. 42%) and technique survival were also similar. CONCLUSIONS: In patients with kidney failure and severe metabolic acidosis requiring urgent KRT, urgent-start PD was associated with similar trajectories of acid-base correction and similar short-term clinical outcomes compared with HD, supporting PD as a safe and metabolically effective alternative in this setting.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.