背景：临床实践指南强调肾脏替代治疗的共同决策，然而，人们对文化差异对这一过程的影响知之甚少。我们进行了回顾性图表审查，以探讨美国华裔患者透析决策和开始的过程和时机，以为该人群提供优质的肾脏护理。
方法：参与者在塔夫茨医疗中心接受门诊治疗，在透析诊所接受透析，公司。波士顿或萨默维尔，2001-2021年硕士。诊所图表审查来自人口统计，临床,以及来自180名参与者的临终护理信息(82名美籍华人，其他98例）来自4期慢性肾脏病（CKD）和透析开始。
结果：华裔美国参与者年龄较大（平均70岁vs.59，p<0.0001)，不太可能说英语(12%vs.87%,p<0.0001),和使用口译员服务更多(80%与11%,p<0.0001)。美籍华人参与者的访问次数更多（中位数为14vs.10，p=0.005)；更经常由家庭成员陪同(75%vs.40%,p<0.001)；医疗保健代理文档的比率显著较低(35%与55%,p=0.006)。首次CKD4次访问和首次透析之间的月数没有统计学差异。两组均以相同的平均eGFR和相似的永久透析接入率开始透析。美籍华裔参与者在透析开始时血清白蛋白显著降低(平均3.3g/dLvs3.7g/dL,p=0.0003)。文件反映了关于非透析护理的对话数量很少，临终规划,或在所有访问中两组的姑息治疗。
结论：两组CKD4和透析开始之间的时间相同，表明护理的总体结果相似。图表文档表明，华裔美国参与者对肾病学家的访问次数明显更高，其中注意到有关透析的讨论，并且更有可能有家人在场。更少的华裔美国人参与者完成了医疗保健代理。在所有研究参与者中，医疗保健代理，代码状态,姑息治疗讨论的报告频率低于预期.这些发现突出了姑息治疗临床医生和肾病学家之间合作的机会。
BACKGROUND: Clinical practice guidelines emphasize shared decision-making for kidney replacement treatment, yet little is known about the influence of cultural differences on that process. We undertook a retrospective chart
review to explore the process and timing of dialysis decision making and initiation in Chinese American patients to provide quality kidney care for this population.
METHODS: Participants received outpatient care at Tufts Medical Center and dialysis at Dialysis Clinic, Inc. Boston or Somerville, MA from 2001-2021. Clinic chart
review sourced demographic, clinical, and end-of-life care information from 180 participants (82 Chinese American, 98 other) from stage 4 chronic kidney disease (CKD) and dialysis initiation.
RESULTS: Chinese American participants were older (mean 70 vs. 59, p < 0.0001), less likely to speak English (12% vs. 87%, p < 0.0001), and used interpreter services more (80% vs. 11%, p < 0.0001). Chinese American participants had more visits (median 14 vs. 10, p = 0.005); were more often accompanied by family members (75% vs. 40%, p < 0.001); and had significantly lower rates of healthcare proxy documentation (35% vs. 55%, p = 0.006). There was no statistical difference in months between first CKD 4 visit and first dialysis. Both groups started dialysis at the same average eGFR and with similar rates of permanent dialysis access. Chinese American participants had significantly lower serum albumin at dialysis initiation (mean 3.3 g/dL vs 3.7 g/dL, p = 0.0003). Documentation reflected a low number of conversations about non-dialytic care, end-of-life planning, or palliative care in both groups across all visits.
CONCLUSIONS: The time between CKD 4 and dialysis initiation was the same in both groups, suggesting a similar overall outcome of care. Chart documentation suggests that Chinese American participants had a significantly higher number of visits with nephrologists where discussion about dialysis was noted and were more likely to have a family member present at the visit. Fewer Chinese American participants completed healthcare proxies. Among all study participants, healthcare proxy, code status, and palliative care discussions were reported less frequently than expected. These findings highlight opportunities for collaboration between palliative care clinicians and nephrologists.
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