Primary cause of respiratory acidosis?

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Excess CO2 accumulation from inadequate ventilation is what drives respiratory acidosis. When ventilation is reduced, CO2 builds up in the blood. CO2 combines with water to form carbonic acid, which dissociates into hydrogen ions and bicarbonate. The increase in hydrogen ions lowers the blood pH, producing acidosis. If CO2 were being lost in excess, the pH would rise (respiratory alkalosis). Metabolic disturbances that produce or remove H+ (without a primary ventilation problem) cause metabolic acidosis or alkalosis, not respiratory acidosis. The kidneys can compensate by increasing bicarbonate reabsorption and acid excretion, but this renal adjustment occurs after the initial CO2-driven disturbance.