Journal of Nephrology最新文献

{"title":"KDIGO and the sick planet: a green nephrology controversy in a moment of contrasts.","authors":"Giorgina Barbara Piccoli, Nathan Berman Parks","doi":"10.1007/s40620-025-02309-2","DOIUrl":"10.1007/s40620-025-02309-2","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"813-814"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosing practices, pharmacokinetics, and effectiveness of allopurinol in gout patients receiving dialysis: a scoping review.","authors":"Noha A Kamel, Michael A Stokes, Daniel F B Wright, Kamal Sud, Surjit Tarafdar, Ronald L Castelino, Sophie L Stocker","doi":"10.1007/s40620-025-02269-7","DOIUrl":"10.1007/s40620-025-02269-7","url":null,"abstract":"<p><p>Urate and oxypurinol, allopurinol's active metabolite, are predominantly eliminated by the kidneys. Therefore, optimising allopurinol dosing in patients on dialysis is challenging. This review explores allopurinol dosing practices, oxypurinol pharmacokinetics, and effectiveness in gout patients receiving haemodialysis or peritoneal dialysis (PD). Five databases and grey literature were searched. Studies on gout patients on allopurinol, receiving dialysis, and reporting dosing, pharmacokinetics, or effectiveness (reduction in urate and/or gout flares) were included. Abstract, full text screening and data extraction were done by two authors. Studies were grouped by dialysis modality. Eighteen studies were identified including 390 patients, most (n = 274, 70%) on haemodialysis with allopurinol administered after dialysis. The peritoneal dialytic clearance of oxypurinol (3.14 mL/min, n = 5) and urate (2.7-4 mL/min, n = 25) was similar. The haemodialytic clearance was 78-137 mL/min for oxypurinol (n = 21) and 80-165 mL/min for urate (n = 19). Allopurinol doses were higher in haemodialysis (100-600 mg/day) than PD (110-125 mg/day). Haemodialysis sessions decreased oxypurinol and urate concentrations by 39-57% (n = 30) and 56-71% (n = 6), respectively. Over time (1-230 days), urate concentrations in haemodialysis (n = 85) reduced by 14-41%. Target serum urate (< 0.36 mmol/L) was achieved in 61% (20/33) and 47% (13/28) of haemodialysis and PD patients, respectively. Gout flares decreased from 2 to 0.1 attacks/year in patients receiving dialysis (n = 79). Oxypurinol and urate clearance by haemodialysis was higher than PD, necessitating higher doses of allopurinol. POST dialysis allopurinol doses titrated to target urate are suggested. Future studies considering the impact of dialysis modality on allopurinol dose requirements are needed.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"859-875"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-physician communication in advanced kidney disease: a narrative review.","authors":"Mohadese Golsorkhi, Niloufar Ebrahimi, Mehrbod Vakhshoori, Sayna Norouzi, Amir Abdipour","doi":"10.1007/s40620-024-02176-3","DOIUrl":"10.1007/s40620-024-02176-3","url":null,"abstract":"<p><p>The increasing prevalence of kidney failure highlights the crucial need for effective patient-physician communication to improve health-related quality of life and ensure adherence to treatment plans. This narrative review evaluates communication practices in the context of advanced kidney disease, focusing on the frameworks of shared decision-making, advanced care planning, and communication skills training among nephrologists. The findings highlight the significant gaps in patient-physician communication, particularly in the domains of advanced care planning, shared decision-making, and dialysis withdrawal. When communication in such situations falls short, it affects patient satisfaction and outcomes. Effective communication is essential for managing advanced kidney disease, requiring a patient-centered approach that includes patients, families, and healthcare providers in care planning. This review advocates for a more integrated, empathic approach to healthcare interactions, emphasizing the importance of including patients, their families, and healthcare providers in a collaborative model based on goals of care. Moreover, it highlights the role of patient-reported outcome measures and patient experience of care in assessing the quality of care in dialysis settings. Here, we call for enhanced training programs regarding communication skills for physicians and emphasize the need for systemic changes to foster patient-centered communication.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"827-843"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease awareness: a cross-sectional study in primary care settings in Türkiye.","authors":"Esra Gök, Mustafa Kürşat Şahin","doi":"10.1007/s40620-025-02210-y","DOIUrl":"10.1007/s40620-025-02210-y","url":null,"abstract":"<p><strong>Background: </strong>Raising awareness of chronic kidney disease (CKD) is essential for early detection and prevention, since the condition remains largely underdiagnosed, particularly in primary care settings. The present study aimed to evaluate awareness levels regarding the causes and symptoms of CKD among individuals receiving primary care.</p><p><strong>Methods: </strong>This cross-sectional study included 457 participants recruited from two primary care centers in Türkiye using systematic random sampling. The data were collected via face-to-face interviews using a pre-tested questionnaire between April and June 2023. Awareness levels were classified using Bloom's cutoff points-high awareness (≥ 80%), moderate awareness (60-79%), and low awareness (< 60%).</p><p><strong>Results: </strong>The mean age of the participants was 42.3 ± 14.9 years. The study population consisted of 55.4% women, 51.2% of the participants were aged 18-39, 74.6% were married, and 53.4% held at least a university bachelor's degree. As for CKD awareness, 64.1% were aware that CKD can be caused by pain medication, 56% that it can be caused by hypertension, and 48.8% that it can result from diabetes. Additionally, 58.6% were aware that swelling of the feet and ankles can represent a symptom of CKD. Awareness of the causes and symptoms of CKD was low in 78.6% of our participants (n = 359), moderate in 17.5% (n = 80) and high in 3.9% (n = 18). Individuals who recalled having been informed about these causes and symptoms by their primary care physicians exhibited higher awareness. No significant differences in awareness were observed across different sociodemographic groups. A positive correlation was observed between awareness of the causes of CKD and awareness of its symptoms.</p><p><strong>Conclusions: </strong>Awareness of CKD causes and symptoms among the participants was limited, nearly half being unaware of key risk factors such as painkiller use, obesity, hypertension, smoking, diabetes, and herbal product use. Increased education, particularly by primary care physicians, may improve awareness and early detection rates.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"979-988"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of secondary hyperparathyroidism in hemodialysis patients: a comparison between two Italian centers to evaluate real-world guideline implementation.","authors":"Fabio Malberti, Stefano Possenti, Paola Pecchini, Bernardo Lucca, Gianluca Marchi, Roberto Zubani, Giusy Chiarelli, Chiara Manenti, Marina Foramitti, Federico Alberici","doi":"10.1007/s40620-025-02227-3","DOIUrl":"10.1007/s40620-025-02227-3","url":null,"abstract":"<p><strong>Background: </strong>Even though calcimimetics and active vitamin D are frequently used, studies using data from dialysis Registries have shown a progressive increase in parathyroid hormone (PTH) levels in the dialysis population over the last 20 years. In the relatively small sample of Italian patients included in the DOPPS phase 5 (n = 449), elevated or suppressed PTH levels were observed in 14% and 34% of patients, respectively. The aim of this study was to assess mineral metabolism parameters and treatment strategies in the hemodialysis population of two Centers in Northern Italy.</p><p><strong>Methods: </strong>We included all chronic hemodialysis patients treated between September and October 2023 at the Dialysis Centers of Cremona (n = 177) and Brescia (n = 315). Both Dialysis Units followed the KDIGO guidelines. However, differences in treatment strategies were noted. Patients in Brescia were systematically prescribed 25-OH vitamin D, while in Cremona, if 1-25 vitamin D was prescribed, 25-OH vitamin D was discontinued. In the Brescia Center, all patients used a 1.50 mmol/l calcium dialysate concentration, while in Cremona patients with hypercalcemia or suppressed PTH levels were prescribed a 1.25 mmol/l calcium dialysate concentration. Mineral metabolism parameters were evaluated and compared to KDIGO recommendations in both settings.</p><p><strong>Results: </strong>In the hemodialysis population considered, the prevalence of high (> 600 pg/ml) or suppressed (< 150 pg/ml) PTH levels was, 8.1% and 24%, respectively. Patients treated at the Brescia Center had significantly lower serum calcium and phosphate levels as compared to patients treated in Cremona. However, serum PTH and 25-vitamin D levels were higher in Brescia. In Brescia, native vitamin D was prescribed more frequently than in Cremona (81.9% vs 5.1%, p < 0.001). In Cremona, both active vitamin D and calcimimetics were prescribed more frequently than in Brescia (respectively, 62.1% and 50.9% vs 39.7% and 27.2%, p < 0.001). The prevalence of hypercalcemia (Brescia: 1.6%, Cremona: 1.7%), hypocalcemia (Brescia: 19%, Cremona: 16%), hyperphosphatemia (Brescia: 35%, Cremona: 40%), and elevated PTH levels (Brescia: 7.6%, Cremona: 9.0%) did not differ significantly. Suppressed PTH levels were more frequent in patients treated in Cremona (35% vs 20%, p < 0.001).</p><p><strong>Conclusions: </strong>Our study found, in the two clinical settings of the study, a lower prevalence of patients with elevated or suppressed PTH levels compared to the Italian patients included in DOPPS. Despite different treatment strategies, the prevalence of elevated PTH levels was similar in the two Centers. This suggests that different therapeutic strategies may be equally effective in controlling secondary hyperparathyroidism.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1009-1015"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of exercise training on quality of life in people with chronic kidney disease requiring dialysis. A systematic review with meta-analysis.","authors":"Annette Traise, Gudrun Dieberg, Elizabeth Degotardi, Bailey Hart, Fiza Kaippilly, Darcy McInnes, Melissa J Pearson, David Ryan, Neil A Smart","doi":"10.1007/s40620-025-02245-1","DOIUrl":"10.1007/s40620-025-02245-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a debilitating condition associated with poor health outcomes, including reduced quality of life (QoL), frequent hospitalisation and premature mortality.</p><p><strong>Aim: </strong>This study aimed to determine the effect of exercise training on health-related QoL in individuals with CKD requiring dialysis, focusing on mental health scores. Secondary aims included analysing the effect of exercise modality, intensity, and delivery context to maximise exercise training benefits for QoL. Additionally, differences in mental component summary and physical component summary scores using CKD-specific generic QoL patient reported outcome measures were examined.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus up to November 14th, 2024, identified randomised controlled trials (RCTs) comparing exercise training to usual care in CKD patients requiring dialysis. Twenty-five RCTs met the inclusion criteria and were pooled for meta-analyses.</p><p><strong>Results: </strong>Pooled analysis revealed significant improvements in QoL scores for mental component summary (MD 3.33 [1.24, 5.41], p = 0.002) and physical component summary (MD 3.75, [2.28, 5.23], p < 0.00001) compared to the usual care. A statistically significant improvement in the mental component summary was found for aerobic training (p = 0.02) and resistance training (p = 0.04). Moderate intensity (p = 0.003), an intervention duration of 12-26 weeks (p = 0.0004), interdialytic delivery (p = 0.003), intradialytic delivery (p = 0.03) and supervised training (p = 0.002) all demonstrated statistically significant improvements in mental component summary. The short form (SF)-36 demonstrated significant improvements in mental component summary (MD 4.15 [1.54, 6.76], p = 0.002), while the kidney disease QoL patient-reported outcome measure did not show significant improvement (p = 0.33).</p><p><strong>Conclusions: </strong>Supervised, inter-dialytic or intra-dialytic exercise, including aerobic or resistance training at a moderate intensity for up to 26 weeks, can significantly improve mental component summary scores in individuals with stage 5 CKD on dialysis.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"893-911"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-stage chronic kidney disease as a risk factor for suicide: a nationwide observational cohort study.","authors":"Hyuk Huh, Kyungdo Han, Minsang Kim, Young Sun Shin, Yeo Jin Yu, Sehyun Jung, Jeong Min Cho, Seong Geun Kim, Semin Cho, Soojin Lee, Eunjeong Kang, Yaerim Kim, Dong Ki Kim, Sehoon Park","doi":"10.1007/s40620-025-02219-3","DOIUrl":"10.1007/s40620-025-02219-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is associated with poor psychological well-being. Whether early-stage CKD is a risk factor for suicide warrants further research.</p><p><strong>Methods: </strong>This nationwide, retrospective, cohort study aimed to evaluate the risk of suicide in patients with early-stage CKD and identify the associated risk factors. A total of 3.945,198 individuals aged ≥ 19 years who underwent the 2009 national health screening in South Korea were studied. Among them, 202,291 patients had early-stage CKD (estimated glomerular filtration rate (eGFR) ≥ 30 and < 60 mL/min per 1.73 m² and/or dipstick albuminuria ≥ 1 +). The study outcome was suicide as confirmed by the nationwide death register based on death certificates.</p><p><strong>Results: </strong>The study population had a mean age of 59 ± 15 years, and 47% were male. We identified 930 suicides (incidence rate, 0.45 per 1000 person-years) in the CKD group and 11,332 suicides (incidence rate, 0.27 per 1000 person-years) in the non-CKD group. Early-stage CKD was significantly associated with an increased risk of suicide in multivariable analysis adjusted for demographic characteristics; lifestyle habits; comorbidities, including diabetes and hypertension; economic status; and depression, bipolar disorder, schizophrenia (hazard ratio, 1.18; 95% confidence interval 1.10‒1.26). Suicide incidence was higher in individuals with proteinuria but preserved kidney function (eGFR > 60 mL/min per 1.73 m² and dipstick albuminuria > 1 +) than in those without CKD.</p><p><strong>Conclusion: </strong>Healthcare providers may need to examine the mental health of patients with early-stage CKD to prevent suicide.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"989-998"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A preventable problem in pregnancy.","authors":"Kareem Elbosaty, Alaa Sabry, Giorgina B Piccoli, Rasha Shemies","doi":"10.1007/s40620-025-02274-w","DOIUrl":"10.1007/s40620-025-02274-w","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1107-1108"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and clinical outcomes of pregnancy-related acute kidney injury (PrAKI) in preeclampsia-complicated pregnancies in Saudi Arabia: a single-center experience.","authors":"Ghada Ankawi, Duaa M Bahkali, Abdullah Alghamdi, Reem Alghamdi, Raghad Alsaaedi, Nedaa Bahkali","doi":"10.1007/s40620-025-02258-w","DOIUrl":"10.1007/s40620-025-02258-w","url":null,"abstract":"<p><strong>Background: </strong> Hypertensive disorders of pregnancy are a leading cause of pregnancy-related acute kidney injury. Data on preeclampsia-complicated pregnancies in the Saudi population are limited.</p><p><strong>Methods: </strong>This retrospective, single-center study analyzed preeclampsia-complicated pregnancies from January 2020 to December 2022, excluding those with chronic kidney disease. Baseline variables collected included age, ethnicity, body mass index, comorbidities, parity, antenatal care, use of in vitro fertilization, and multiple gestation pregnancies. Study outcomes included: 1. Pregnancy-related acute kidney injury incidence, defined as a serum creatinine > 77 µmol/L during pregnancy or an increase > 26.5 µmol/L within six weeks postpartum; 2. Comparison of fetomaternal outcomes between pregnancy-related acute kidney injury and non- pregnancy-related acute kidney injury groups; and 3. Pregnancy-related acute kidney injury risk factors.</p><p><strong>Results: </strong>Pregnancy-related acute kidney injury occurred in 25 (19.4%) of the 129 preeclampsia-complicated pregnancies. It was significantly associated with adverse fetal outcomes, including higher rates of preterm birth (72% vs. 45.2%, P = 0.016), lower birth weight (1500 g vs. 2277.5 g, P = 0.002), intrauterine growth restriction (36% vs. 14.4%, P = 0.013), and intrauterine fetal death (28% vs. 8.7%, P = 0.008). However, no significant differences were observed in maternal outcomes. Independent predictors of pregnancy-related acute kidney injury included preexisting diabetes mellitus (Odds Ratio [OR] 3.534, P = 0.048), Hemolysis, Elevated Liver enzymes, and Low Platelet count. syndrome (OR 25.250, P = 0.004), and intrauterine fetal death (OR 4.105, P = 0.013). Antenatal care was associated with a reduced risk of pregnancy-related acute kidney injury (OR 0.196, P = 0.033).</p><p><strong>Conclusions: </strong>pregnancy-related acute kidney injury is a common complication in preeclampsia-complicated pregnancies and is associated with poor fetal outcomes. Early identification and provision of antenatal care can significantly reduce the risk of pregnancy-related acute kidney injury.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1093-1100"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal seafood-borne carbapenem-resistant Vibrio cholerae peritonitis in a PD patient: lessons for the clinical nephrologist.","authors":"Kornrawee Sawasdichai, Piyaporn Towannang, Tanittha Chatsuwan, Dhammika Leshan Wannigama, Talerngsak Kanjanabuch","doi":"10.1007/s40620-025-02277-7","DOIUrl":"10.1007/s40620-025-02277-7","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1127-1130"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}