Journal of Renal Nutrition最新文献

{"title":"Message From the Chair","authors":"Jill Hoyt RDN, CD","doi":"10.1053/j.jrn.2024.07.011","DOIUrl":"10.1053/j.jrn.2024.07.011","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Page 471"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S105122762400164X/pdfft?md5=c491b11eaeab60ff6ef196f73546aec3&pid=1-s2.0-S105122762400164X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Bone Mineral Density in Patients With Non-dialysis-Dependent Chronic Kidney Disease Are Associated With Body Composition","authors":"","doi":"10.1053/j.jrn.2024.03.011","DOIUrl":"10.1053/j.jrn.2024.03.011","url":null,"abstract":"<div><h3>Objective</h3><p>Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).</p></div><div><h3>Methods</h3><p>Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height²) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ −1.0.</p></div><div><h3>Results</h3><p>The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (<em>P</em> = .031), ALSTI (<em>P</em> = .021), a trend for BMD (<em>P</em> = .053), and an increase in percentage fat mass (<em>P</em> = .044) and LCI (<em>P</em> = .032). Females had a reduction in BMD (<em>P</em> = .034), ALST (<em>P</em> = .026), and ALSTI (<em>P</em> = .037). Patients with low BMD at baseline had lower LST (<em>P</em> = .013), ALST (<em>P</em> = .023), and percentage fat mass (<em>P</em> = .037) than those with normal BMD. Additionally, reductions in LST (<em>P</em> = .041), ALST (<em>P</em> = .006), and ALSTI (<em>P</em> = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, <em>P</em> = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, <em>P</em> = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, <em>P</em> = .037), independent of fat mass and LCI.</p></div><div><h3>Conclusions</h3><p>Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 391-400"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624000633/pdfft?md5=8e6e1240a29b6cc293fee5bf4c93fb1e&pid=1-s2.0-S1051227624000633-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflecting on Remarkable Years at the Journal of Renal Nutrition: Innovation in Dietary and Nutritional Interventions in Kidney Health and Disease","authors":"","doi":"10.1053/j.jrn.2024.07.002","DOIUrl":"10.1053/j.jrn.2024.07.002","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 371-373"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624001547/pdfft?md5=06fa9824a2a6a82c1bde9efc868e7c32&pid=1-s2.0-S1051227624001547-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Peritoneal Equilibration Test in Assessing Folate Transport During Peritoneal Dialysis","authors":"","doi":"10.1053/j.jrn.2024.02.003","DOIUrl":"10.1053/j.jrn.2024.02.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Low plasma folate levels have been reported in patients undergoing hemodialysis and peritoneal dialysis (PD) in clinical studies. However, folate transport has never been mentioned as a factor contributing to low plasma folate levels in patients undergoing PD. The peritoneal equilibrium test (PET) assesses the plasma creatinine level and glucose transport abilities. This study aimed to evaluate the association between plasma folate levels and folate transport during PD based on PET grades.</p></div><div><h3>Methods</h3><p>This study recruited 50 patients who underwent PD for ≥3 months and were categorized according to PET grades. Data regarding plasma folate levels and dialysate folate were collected. The primary outcomes were the relationship between the PET grade and plasma folate level and between the PET grade and dialysate-to-plasma folate concentration ratio (D/P folate). Furthermore, the difference in the plasma folate level and D/P folate between men and women was assessed.</p></div><div><h3>Results</h3><p>The plasma folate level and the D/P folate significantly differed among the 4 PET groups (both <em>P</em> &lt; .001). PET grade was significantly negatively correlated with plasma folate levels (r = −0.56, <em>P</em> &lt; .001) and positively correlated with D/P folate (r = 0.686, <em>P</em> &lt; .001). In subgroup analysis, neither the plasma folate level nor the D/P folate significantly differed between men and women.</p></div><div><h3>Conclusions</h3><p>Our study provides clinical evidence that the PET grade is associated with the plasma folate level and D/P folate, regardless of sex. Larger cohort studies are warranted to assess the importance of folate supplementation during PD based on PET grades.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 463-468"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624000347/pdfft?md5=603d3591cffb554d3363cb7dfda9753e&pid=1-s2.0-S1051227624000347-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Niacinamide Supplementation on Phosphate Concentrations in Dutch Dialysis Patients: A Randomized Crossover Trial","authors":"","doi":"10.1053/j.jrn.2024.02.005","DOIUrl":"10.1053/j.jrn.2024.02.005","url":null,"abstract":"<div><h3>Objective</h3><p>Hyperphosphatemia is a common complication in patients with kidney failure, despite the use of phosphate binders. Vitamin B3, either in the form of niacin or niacinamide (NAM), shows potential as “add-on” treatment to reduce serum phosphate concentrations in this population. NAM seems to lack many of the side effects that are observed with niacin. The aim of this study was to investigate whether NAM is an effective and acceptable treatment in reducing serum phosphate concentrations in patients with kidney failure.</p></div><div><h3>Methods</h3><p>DiaNia was a double-blind placebo-controlled randomized crossover trial, comparing NAM (250-500 mg/day) to placebo as “add-on” treatment to an individual treatment with approved phosphate binders for 12 weeks in patients receiving hemodialysis. The primary outcome was serum phosphate concentrations, and the secondary outcomes were platelet counts as well as drop-outs due to side effects. Data were analyzed using both per-protocol and intention-to-treat analyses.</p></div><div><h3>Results</h3><p>Mean age of the per-protocol population (n = 26) was 63.6 ± 17.2 years and 53.8% were men. NAM treatment significantly reduced serum phosphate with 0.59 mg/dL (p = .03). Linear mixed-effects models demonstrated superiority of 12 weeks NAM over 12 weeks placebo with a between-treatment difference of 0.77 mg/dL (95% CI 0.010, 1.43; <em>P</em> = .03). Similar results, although not significant, were found in the intention-to-treat population. We found no between-treatment differences in platelet counts and during the NAM treatment we observed 3 drop-outs due to side effects (8.6%).</p></div><div><h3>Conclusion</h3><p>NAM is effective in reducing serum phosphate concentrations in patients with kidney failure receiving hemodialysis. In addition, NAM is well-tolerated and seems not to increase the risk of thrombocytopenia. Thus, NAM can be valuable as “add-on” treatment to combat hyperphosphatemia in patients with kidney failure. However, more research in larger populations is needed to confirm this.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 454-462"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624000360/pdfft?md5=7837abd9936820eacbf5849f93af8335&pid=1-s2.0-S1051227624000360-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysgeusia and Chronic Kidney Disease: A Scoping Review","authors":"","doi":"10.1053/j.jrn.2024.04.005","DOIUrl":"10.1053/j.jrn.2024.04.005","url":null,"abstract":"<div><p>Dysgeusia is a common altered taste perception in chronic kidney disease patients. The study aims to identify available treatments for educating, screening, and clinically managing dysgeusia in this population. A scoping review was conducted following the protocol of Arksey and O'Malley, incorporating the Joanna Briggs Institute methodology, and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Among the 424 identified records, 13 studies were included. Screening methodologies, educational strategies, particularly a hospital-based program focusing on salt reduction, showed a significant improvement in dysgeusia (<em>P</em> &lt; .001). The identified clinical treatments exclusively included oral zinc supplementation, with dosages ranging from 50 to 220 mg, reporting heterogeneous results not consistent across different studies. The personalized management of dysgeusia associated with chronic kidney disease is crucial, requiring targeted education and treatment protocols to prevent and address nutritional complications such as malnutrition.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 374-390"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624000670/pdfft?md5=64e7ddbb062f46f9281e3ab5a643f8f3&pid=1-s2.0-S1051227624000670-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Nutrition Tool to Improve the Adherence to Healthy Dietary Pattern in the Mexican Population With Chronic Kidney Disease","authors":"Ari Cisneros MS, RD,&nbsp;Paola Alvarado RD,&nbsp;Xunaxi García RD","doi":"10.1053/j.jrn.2024.07.012","DOIUrl":"10.1053/j.jrn.2024.07.012","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages e1-e4"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624001651/pdfft?md5=7f5914cb254fa1f6329bc4c078426fbc&pid=1-s2.0-S1051227624001651-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease","authors":"","doi":"10.1053/j.jrn.2024.01.005","DOIUrl":"10.1053/j.jrn.2024.01.005","url":null,"abstract":"<div><h3>Objective</h3><p>Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease<span><span> (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing </span>hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy.</span></p></div><div><h3>Design and Methods</h3><p>Patient-facing resources were collected from Google, Yahoo, and Facebook in June–July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food subgroups, and individual food items was categorized as “restricted,” “recommended,” “mixed,” and “not mentioned.” Information on publication date, source, and author(s), phosphorus bioavailability, and demineralization were also collected.</p></div><div><h3>Results</h3><p><span><span>After removing duplicates, 199 resources from Google and Yahoo and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021 and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focuses on restricting high-phosphorus foods and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole </span>grains<span>, dairy, and plant-based protein foods, although major inconsistencies were noted. Phosphorus bioavailability and </span></span>demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons.</p></div><div><h3>Conclusion</h3><p>Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart-healthy food items and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and health care professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 410-417"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Phosphate Educational Materials for Pediatric Chronic Kidney Disease: Are Confused Messages Reducing Their Impact?","authors":"","doi":"10.1053/j.jrn.2024.02.004","DOIUrl":"10.1053/j.jrn.2024.02.004","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to review the quality and content of phosphate educational materials used in pediatric<span> chronic kidney disease.</span></p></div><div><h3>Methods</h3><p><span>The quality of text-based (TB) pediatric phosphate educational materials was assessed using validated instruments for health literacy demands (Suitability Assessment of Materials, Patient Education Material Assessment Tool [PEMAT-P]) readability (Flesch Reading Ease, and Flesch-Kincaid Grade Level). Codes were inductively derived to analyse format, appearance, target audience, resource type, and content, aiming for intercoder reliability &gt; 80%. The content was compared to Pediatric Renal </span>Nutrition Taskforce (PRNT) recommendations.</p></div><div><h3>Results</h3><p>Sixty-five phosphate educational materials were obtained; 37 were pediatric-focused, including 28 TB. Thirty-two percent of TB materials were directed at caregivers, 25% at children, and 43% were unspecified. Most (75%) included a production date, with 75% produced &gt;2 years ago. The median Flesch Reading Easetest score was 68.2 (interquartile range [IQR] 61.1–75.3) and Flesch-Kincaid Grade Level was 5.6 (IQR 4.5–7.7). Using Suitability Assessment of Materials, 54% rated “superior” (≥70), 38% rated “adequate” (40–69), and 8% rated “not suitable” (≤39). Low-scoring materials lacked a summary (12%), cover graphics (35%), or included irrelevant illustrations (50%). Patient Education Material Assessment Tool-P scores were 70% (IQR 50–82) for understandability and 50% (IQR 33–67) for actionability. An intercoder reliability of 87% was achieved. Over half of limited foods are in agreement with PRNT (including 89% suggesting avoiding phosphate additives). Recommendations conflicting with PRNT included reducing legumes and whole grains. Over a third contained inaccuracies, and over two-thirds included no practical advice.</p></div><div><h3>Conclusions</h3><p>TB pediatric phosphate educational materials are pitched at an appropriate level for caregivers, but this may be too high for children under 10 years. The inclusion of relevant illustrations may improve this. Three-quarters of materials scored low for actionability. The advice does not always align with the PRNT, which (together with the inaccuracies reported) could result in conflicting messages to patients and their families.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 401-409"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Malnutrition According to the Global Leadership Initiative on Malnutrition Criteria Combined With Kidney Dysfunction to Determine Mortality in Inpatients","authors":"","doi":"10.1053/j.jrn.2024.03.010","DOIUrl":"10.1053/j.jrn.2024.03.010","url":null,"abstract":"<div><h3>Objective</h3><p>The clinical impact of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with kidney dysfunction<span><span> remains poorly understood. This study investigated the usefulness of GLIM criteria for malnutrition in predicting mortality in patients with kidney dysfunction<span><span> and different clinical renal states, including no kidney disease (NKD), </span>acute kidney injury (AKI), and </span></span>chronic kidney disease (CKD).</span></p></div><div><h3>Methods</h3><p><span>This single-center retrospective cohort study<span> included 6,712 patients aged ≥18 admitted between 2018 and 2019. The relationship between the estimated glomerular filtration rate<span> (eGFR) groups, nutritional status based on the GLIM criteria, and the incidence of all-cause mortality was evaluated using a multivariate Cox proportional hazards model. Malnutrition was defined as at least one phenotype (weight loss, low </span></span></span>body mass index, or reduced muscle mass) and one etiological criterion (reduced intake/assimilation or disease burden/inflammation).</p></div><div><h3>Results</h3><p>Multivariate Cox proportional hazards model showed that eGFR ≤29 (vs. eGFR: 60-89, adjusted hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.52-2.22), 30-59 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.20-1.64), and ≥90 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.14-1.71), moderate and severe malnutrition (vs. without malnutrition, adjusted HR = 1.38 [1.18-1.62] and 2.18 [1.86-2.54], respectively) were independently associated with the incidence of death. The all-cause mortality rate was higher in patients with malnutrition or eGFR ≤29 (adjusted HR, 3.31; 95% CI: 2.51-4.35) than in patients without malnutrition or eGFR 60-89. Furthermore, moderate and severe malnutrition (vs. no malnutrition) was independently associated with death in patients with NKD, AKI, and CKD.</p></div><div><h3>Conclusion</h3><p>Malnutrition based on the GLIM criteria was associated with increased all-cause mortality in inpatients, and malnutrition combined with kidney dysfunction was associated with a higher risk of mortality. Furthermore, patients with NKD, AKI, and CKD showed an association between malnutrition based on GLIM criteria and mortality.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"34 5","pages":"Pages 418-426"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}