Journal of Renal Nutrition最新文献

{"title":"The Association of Odor Identification With Nutritional Status and Systemic Inflammation in Patients With Advanced Chronic Kidney Disease","authors":"Ragibe Gulsah Dilaver MD ,&nbsp;Andrew Guide MSc ,&nbsp;Robert Greevy PhD ,&nbsp;Talat Alp Ikizler MD ,&nbsp;Ayse Zeynep Bal MD","doi":"10.1053/j.jrn.2024.07.018","DOIUrl":"10.1053/j.jrn.2024.07.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Anorexia is common in patients with chronic kidney disease (CKD) and could lead to protein-energy wasting (PEW). An altered sense of smell, a reflection of olfactory dysfunction, is a potential mechanism that exacerbates the impact of anorexia on PEW. In this study, we examined the extent of the altered sense of smell and its association with PEW in patients with moderate-to-advanced CKD.</div></div><div><h3>Methods</h3><div>We studied 139 individuals (34 healthy subjects– controls, 50 patients with stage 3-4 CKD, and 55 patients on maintenance hemodialysis (MHD)) using the odor identification test (Sniffin’ Sticks odor screening test containing 12 different smells). The odor identification test was scored as either correct or incorrect, and each participant's total odor score was calculated. Malnutrition inflammation score (MIS) was used to assess PEW.</div></div><div><h3>Results</h3><div>Patients with CKD had higher C-reactive protein and lower serum albumin concentrations compared to healthy individuals. Total odor scores were different between groups, with controls having the highest scores and MHD patients having the lowest scores. A similar difference was observed in MIS, and MHD patients displayed the worst nutritional score (<em>P</em> ≤ .001). The number of participants with severe olfactory dysfunction (≤6 correct answers) was significantly higher in the CKD and MHD groups compared to the controls (<em>P</em> ≤ .01). There was an inverse trend between the total odor score and the MIS score for the study population. However, this relationship was not statistically significant (r = −0.124, <em>P</em> = .21).</div></div><div><h3>Conclusion</h3><div>This cross-sectional study suggests that olfactory dysfunction, as assessed by the odor identification test, is altered in patients with advanced CKD, most notably in ones on MHD. Although the diminished sense of smell was observed alongside development of PEW, we explicitly noted that there is no statistically significant correlation.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 48-55"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057036","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":"Potassium-Based Sodium Substitutes Impact the Sodium and Potassium Content of Foods","authors":"Kelly Picard PhD, RD ,&nbsp;Diana R. Mager PhD, RD ,&nbsp;Peter A. Senior MBBS, PhD ,&nbsp;Caroline Richard PhD, RD","doi":"10.1053/j.jrn.2024.05.010","DOIUrl":"10.1053/j.jrn.2024.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>Potassium-based sodium substitutes (PBSS) can be used to replace sodium during food processing. How potassium and sodium content is associated with PBSS is not known. The objectives of the study were to describe the prevalence of PBSS by sodium content claim category and describe how PBSS are associated with sodium and potassium concentrations by sodium level.</div></div><div><h3>Design and Methods</h3><div>This cross-sectional analysis used the July 2018 version of the United States Department of Agriculture’s Branded Food Products Database. Products were divided into sodium content claim category and were analyzed for the presence of PBSS. Products with nonmissing values for sodium and potassium were grouped by sodium level and analyzed for the prevalence of PBSS to explore potassium and sodium concentration. Column proportion z-test with the Bonferroni correction was used to explore the occurrence of PBSS by sodium content claim category. Mann-Whitney U-test was used to assess differences in potassium and sodium concentrations across sodium levels and within levels by the presence/absence of PBSS.</div></div><div><h3>Results</h3><div>The prevalence of PBSS in the categories “without a sodium content claim” (2.4%), “lightly salted” (0.5%), and “unsalted” claims (0.6%) were statistically significantly lower than prevalence of PBSS in the “sodium free” (9.5%), “low sodium” (10.3%), and “reduced sodium” claim categories (23.3%; all <em>P</em> &lt; .01). Among the group of products with serving sizes more than 30 g containing PBSS, there was a 357 mg per serving higher median sodium concentration and a 160 mg per serving higher median potassium concentration compared to the group without PBSS (both <em>P</em> &lt; .01).</div></div><div><h3>Conclusion</h3><div>In the “reduced sodium” claim category, a higher prevalence of PBSS was found compared to other sodium claim categories. The presence of PBSS was associated with higher potassium and sodium concentrations in foods.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 64-71"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288850","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":"Risk Prediction Models for Sarcopenia in Dialysis Patients: A Systematic Review","authors":"Ying-Jie Leng MSc ,&nbsp;Guo-Rong Wang PhD ,&nbsp;Ruo-Nan Xie MSc ,&nbsp;Xin Jiang MSc ,&nbsp;Cheng-Xiang Li MSc ,&nbsp;Zhuo-Miao Nie MSc ,&nbsp;Tao Li MSc","doi":"10.1053/j.jrn.2024.05.009","DOIUrl":"10.1053/j.jrn.2024.05.009","url":null,"abstract":"<div><div>Nowadays, numerous studies have developed risk prediction models for sarcopenia in dialysis patients. However, the quality and performance of these models have not been integrated. The purpose of our study is to provide a comprehensive overview of the current risk prediction models for sarcopenia in dialysis patients and to offer a reference for the development of high-quality prediction models. Ten electronic databases were searched from inception to March 8, 2024. Two researchers independently assessed the risk of bias and applicability of the studies, and used Revman, 5.4, software to conduct a meta-analysis of common predictors in the models. A total of 12 studies described 13 risk prediction models for dialysis patients with sarcopenia. In dialysis patients, the prevalence of sarcopenia ranged from 6.60% to 63.73%. The area under curve (AUC) of the 13 models ranged from 0.776 to 0.945. Only six models (AUC ranging from 0.73 to 0.832) were internally validated, while two were externally evaluated (AUC ranging from 0.913 to 0.955). Most studies had a high risk of bias. The most common effective predictors in the models were age, body mass index, muscle circumference, and C-reactive protein. Our study suggests that developing a prediction model for the onset of sarcopenia in dialysis patients requires a rigorous design scheme, and future verification methods will necessitate multicenter external validation.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 146-155"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288851","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":"The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease – Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce","authors":"An Desloovere ,&nbsp;Nonnie Polderman RD ,&nbsp;José Renken-Terhaerdt ,&nbsp;Vanessa Shaw MA, PG Diploma in Dietetics ,&nbsp;Caroline Anderson PhD ,&nbsp;Larry A. Greenbaum MD, PhD ,&nbsp;Christina L. Nelms MS, RDN ,&nbsp;Leila Qizalbash BSc (Hon) Nutrition and Dietetics, PG Dip ,&nbsp;Stella Stabouli MD, PhD ,&nbsp;Jetta Tuokkola RD, PhD ,&nbsp;Bradley A. Warady MD ,&nbsp;Johan Vande Walle MD, PhD ,&nbsp;Fabio Paglialonga MD, PhD ,&nbsp;Rukshana Shroff MD, PhD ,&nbsp;Evelien Snauwaert MD, PhD","doi":"10.1053/j.jrn.2024.05.008","DOIUrl":"10.1053/j.jrn.2024.05.008","url":null,"abstract":"<div><div>The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 207-220"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312134","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":"Potassium Food Additives and Dietary Management of Serum Potassium: Proposed Best-Practice Recommendations","authors":"Kelly Picard PhD, RD ,&nbsp;Andrew Morris PhD, RD","doi":"10.1053/j.jrn.2024.07.006","DOIUrl":"10.1053/j.jrn.2024.07.006","url":null,"abstract":"<div><div>The contribution of potassium food additives to total dietary potassium intake is unknown. This poses challenges for individuals living with kidney disease who may need to monitor their potassium intake. Additionally, different countries have varying regulations regarding the reporting of dietary potassium content in foods. This article examines the potential of published food databases to assist clinicians in helping individuals with kidney disease manage their serum potassium levels. It uses the United States Department of Agriculture's Branded Food Products Database as an example. Evidence for potassium additive content in database entries, along with their bioavailability, is discussed, and best-practice recommendations are made based on current evidence. Clinical practice and future research priorities are suggested.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 221-228"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591893","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":"Development and Implementation of a Novel Approach to Dietary Education for People With Inadequate Health Literacy and Advanced Kidney Disease","authors":"S. Olwyn Talbot-Titley DipHSc ,&nbsp;Adam W.F. Mullan MD ,&nbsp;Kelly Lambert PhD","doi":"10.1053/j.jrn.2024.07.008","DOIUrl":"10.1053/j.jrn.2024.07.008","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat.</div></div><div><h3>Design and Methods</h3><div>The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying <em>Cook for Life</em> cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Māori elder and his whānau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the <em>Storybook,</em> a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals.</div></div><div><h3>Results</h3><div>Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style.</div></div><div><h3>Conclusion</h3><div>This practical skill–based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 239-243"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591877","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":"January 2025 Meeting Announcements","authors":"","doi":"10.1053/j.jrn.2024.10.001","DOIUrl":"10.1053/j.jrn.2024.10.001","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Page 244"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143155971","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":"Association of Nutritional Risk Index With Infection-Related Hospitalization and Death After Hospitalization in Patients Undergoing Maintenance Hemodialysis","authors":"Katsuhito Mori MD, PhD ,&nbsp;Yosuke Yamamoto MD, PhD ,&nbsp;Norio Hanafusa MD, PhD ,&nbsp;Suguru Yamamoto MD, PhD ,&nbsp;Shingo Fukuma MD, PhD ,&nbsp;Yoshihiro Onishi PhD ,&nbsp;Masanori Emoto MD, PhD ,&nbsp;Masaaki Inaba MD, PhD","doi":"10.1053/j.jrn.2024.07.017","DOIUrl":"10.1053/j.jrn.2024.07.017","url":null,"abstract":"<div><h3>Objective</h3><div>Patients undergoing dialysis frequently experience hospitalization due to cardiovascular disease (CVD) and infection. This population is also at high risk of rehospitalization and subsequent death. In addition to serious outcomes, hospitalization incurs substantial medical cost. Prevention of hospitalization is accordingly an urgent matter. Here, we examined whether nutritional disorder was associated with hospitalization and subsequent death.</div></div><div><h3>Methods</h3><div>The study was conducted under a prospective design using data from the Japanese Dialysis Outcomes and Practice Pattern Study. The exposure was the Nutritional Risk Index for Japanese Hemodialysis (NRI-JH), through which patients were divided into low-, medium-, and high-risk groups, with the low-risk group as referent. The primary outcome was CVD-related or infection-related hospitalization. Secondary outcome was all-cause mortality. For exploratory analyses, the associations of baseline or latest NRI-JH just before hospitalization, with death after hospitalizations, were examined.</div></div><div><h3>Results</h3><div>Of 4021 patients, 566 patients had CVD-related hospitalization and 375 had infection-related hospitalization during a median follow-up of 2.6 years. NRI-JH at baseline was significantly associated with infection-related hospitalization but not with CVD-related hospitalization, in multivariable Cox models (hazard ratio [HR] 1.46, 95% confidential interval [CI]: 1.09 to 1.97, <em>P</em> = .012 for medium-risk vs. low-risk group) (HR 2.46, 95% CI: 1.81 to 3.35, <em>P</em> &lt; .001 for high-risk vs. low-risk group). NRI-JH was also associated with all-cause mortality. In addition, the baseline and latest high-risk NRI-JH groups were significantly associated with death after both CVD-related and infection-related hospitalizations.</div></div><div><h3>Conclusions</h3><div>A higher nutritional risk as evaluated by NRI-JH was associated with infection-related hospitalization but not with CVD-related hospitalization. However, NRI-JH was significantly associated with death after both CVD-related and infection-related hospitalizations, suggesting that nutritional risk may be separately involved in hospitalization or subsequent death. NRI-JH may be useful in the planning of individual care to improve outcomes.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 187-195"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861464","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":"Assessment of Nutritional Intake in Patients With Kidney Failure Treated by Haemodialysis on Dialysis and Non-dialysis Days","authors":"Haalah Shaaker MSc ,&nbsp;Andrew Davenport MD","doi":"10.1053/j.jrn.2024.07.009","DOIUrl":"10.1053/j.jrn.2024.07.009","url":null,"abstract":"<div><h3>Introduction/Aims/Objective</h3><div>Inadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis day and nondialysis day (NDD) of patients established on HD.</div></div><div><h3>Methods</h3><div>We employed a 2-day dietary record, one on the day of dialysis and one on the NDD, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength, and the body composition was determined using multifrequency bioelectrical impedance recorded postdialysis.</div></div><div><h3>Results</h3><div>We recruited 51 established HD patients dialysing between May 2022 and July 2022, of mean age 60 ± 15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative. Most patients had inadequate consumption of fiber (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), respectively. However, consumption was greater for potassium (<em>P</em> = .007), phosphorus (<em>P</em> = .015), and zinc (<em>P</em> = .032) on NDDs versus dialysis days, but there was no difference in protein or calorie intake between days.</div></div><div><h3>Conclusion</h3><div>Our results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium, and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 172-180.e1"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591876","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":"Efficacy of Lemon Mouthwash in Improving Dry Mouth Symptoms and Salivary Flow in Hemodialysis Patients","authors":"I-Chen Yu RN, PhD ,&nbsp;Ji-Tseng Fang MD","doi":"10.1053/j.jrn.2024.07.007","DOIUrl":"10.1053/j.jrn.2024.07.007","url":null,"abstract":"<div><h3>Objectives</h3><div>Gargling mouthwash is a safe and convenient oral care intervention; it rinses the mouth and increases salivary flow rate. The effectiveness of lemon mouthwash in relieving xerostomia and increasing the salivary flow rate among hemodialysis patients has not been studied. Our study sought to analyze the effectiveness of varying concentrations of lemon in mouthwash solutions on xerostomia and salivary flow rate.</div></div><div><h3>Methods</h3><div>A multi-concentration test was used to assess lemon mouthwash at 20%, 15%, 10%, 5%, and 2.5% concentrations to determine the optimal concentration for relieving dry mouth and increasing salivary flow rate. Generalized estimating equations were used to analyze the differences between various concentrations of lemon mouthwash and baseline values.</div></div><div><h3>Results</h3><div>In total, 44 patients were recruited. The 10% lemon concentration mouthwash was the most effective for increasing salivary flow rate, but the 5% and 2.5% were better accepted by the participants. Our findings can help establish intervention guidelines to relieve xerostomia among hemodialysis patients.</div></div><div><h3>Conclusion</h3><div>Our findings can help establish intervention guidelines to relieve xerostomia among hemodialysis patients.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 163-171"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591878","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}