Clinical journal of the American Society of Nephrology : CJASN最新文献

{"title":"Lifestyle Narrowing in Chronic Kidney Disease: The Hidden Burden of Incremental Symptom Accumulation.","authors":"James O Burton","doi":"10.2215/CJN.0000001261","DOIUrl":"https://doi.org/10.2215/CJN.0000001261","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equipping Nephrology Fellows with the Knowledge, Skills, and Attitudes for the Artificial Intelligence Era.","authors":"Jie Ming Nigel Fong, Angela Yee-Moon Wang","doi":"10.2215/CJN.0000001239","DOIUrl":"https://doi.org/10.2215/CJN.0000001239","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Performance and Risk of Heart Failure, Kidney Failure, and Mortality in CKD: Findings from the CRIC Study.","authors":"Devika Nair, Rebecca T Brown, Michael G Shlipak, Navdeep Tangri, Xiaoming Zhang, Mary F Hannan, Mary B Leonard, James P Lash, Sankar D Navaneethan, Jing Chen, Jiang He, Lawrence J Appel, Hernan Rincon-Choles, Mayank Kansal, Wei Yang, Sarah Schrauben","doi":"10.2215/CJN.0000001219","DOIUrl":"https://doi.org/10.2215/CJN.0000001219","url":null,"abstract":"<p><strong>Background: </strong>Physical performance limitations are common in chronic kidney disease (CKD) and affect independence and survival, yet physical performance is not routinely assessed. We examined whether the Short Physical Performance Battery (SPPB), a multidimensional measure of lower-extremity physical performance, was longitudinally associated with incident heart failure, kidney failure, and mortality.</p><p><strong>Methods: </strong>We evaluated Chronic Renal Insufficiency Cohort (CRIC) Study participants with ≥1 SPPB assessment, administered approximately every 2-3 years. SPPB was modeled per 1-point lower score, and categorically as low (0-6), moderate (7-9), and high (10-12) performance. Associations of baseline and time-updated SPPB with incident heart failure, incident kidney failure and mortality were evaluated using cause-specific Cox models adjusted for demographic and clinical characteristics.</p><p><strong>Results: </strong>Among 3,038 participants, mean age was 63.5 years, 40% were non-Hispanic Black, and mean estimated glomerular filtration rate (eGFR) was 52 mL/min/1.73m2. Median follow-up was 8.5 years, and median baseline SPPB was 10 (8-11). Each 1-point lower baseline SPPB score was associated with 14% higher mortality risk but was not heart failure or kidney failure after full adjustment. In time-updated analyses, each 1-point lower SPPB was associated with a 10% higher heart failure risk and a 15% higher mortality risk. Low and moderate (vs high) SPPB performance categories were associated with 51% and 128% higher heart failure risk and 69% and 224% higher mortality risk, respectively. In contrast, neither baseline nor time-updated SPPB was independently associated with kidney failure.</p><p><strong>Conclusions: </strong>Lower longitudinal physical performance was independently associated with higher risks of heart failure and mortality, but not kidney failure, among adults with CKD. The SPPB may help risk-stratify patients with CKD identifying those at high-risk for cardiovascular outcomes and mortality.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Uromodulin in Dialysis Patients.","authors":"Olivia C Wright, Samantha Gunning, Louis G Baeseman, Rita L McGill","doi":"10.2215/CJN.0000001237","DOIUrl":"10.2215/CJN.0000001237","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Renal Effectiveness of GLP-1RA and SGLT2i in US Veterans with Type 2 Diabetes and CKD.","authors":"Phyo Than Htoo, Elisabetta Patorno, Janinne Ortega-Montiel, Deborah J Wexler, Ariela Orkaby, Julie M Paik","doi":"10.2215/CJN.0000001244","DOIUrl":"https://doi.org/10.2215/CJN.0000001244","url":null,"abstract":"<p><strong>Objective: </strong>To address limited comparative evidence in older, clinically complex patients with type 2 diabetes and moderate-to-advanced chronic kidney disease (CKD), we compared nephroprotective outcomes after GLP-1RA versus SGLT2i initiation among US Veterans aged ≥65 years with type 2 diabetes and CKD stages 3-4 during 2016-2025.</p><p><strong>Methods: </strong>Within the U.S. Veterans Health Administration database, we identified individuals with type 2 diabetes and CKD stage 3-4 (eGFR 15 to <60 mL/min/1.73 m2) initiating GLP-1RA vs SGLT2i. GLP-1RA formulations approved for weight loss were excluded. The primary outcome was a composite of ESKD, sustained 40% decline in kidney function, or all-cause mortality, with individual components being secondary outcomes. After controlling for >100 covariates including comorbidities, medications, clinical parameters, and laboratory results using propensity score matching weights, we estimated hazard ratios and rate differences. Analyses were stratified by CKD stages, HbA1c, and body mass index.</p><p><strong>Results: </strong>We identified 28,365 GLP-1RA and 78,354 SGLT2i initiators [mean (SD) age: 74 (6) years vs. 76 (6) years]. Over a median follow-up of 11 months, the weighted risks for the primary outcome were similar between treatment groups [HR (95% CI): 1.00 (0.94, 1.07); RD per 1,000 person-years (95% CI): 0.0002 (-0.0037, 0.0042)], mainly attributed to the similar risk for all-cause mortality. The risks of the secondary outcomes were higher in GLP-1RA vs. SGLT2i initiators, but higher risks for sustained kidney function decline and ESKD. Findings were consistent across variations in baseline CKD stage, history of CVD, BMI, and HbA1c level. Absolute rate differences for major kidney disease events and ESKD were larger in patients with more advanced CKD stages.</p><p><strong>Conclusions: </strong>These findings suggest broadly comparable overall kidney and survival outcomes, with potential advantages of SGLT2is for the risks of kidney function decline and incident ESKD across metabolic subgroups in this older adult cohort.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engineering an Artificial Kidney.","authors":"Josh Goodrich, Juliana Marçal, Christa Hestekin, Jamie Hestekin, Ira Kurtz","doi":"10.2215/CJN.0000001251","DOIUrl":"https://doi.org/10.2215/CJN.0000001251","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Glycemic Control and Survival in Patients with Type 2 Diabetes on Peritoneal Dialysis: Results from PDOPPS.","authors":"Jennifer K Williams, Mark Lambie, Simon Davies, Brian Bieber, Yong-Lim Kim, Jeffrey Perl, James Fotheringham","doi":"10.2215/CJN.0000001200","DOIUrl":"10.2215/CJN.0000001200","url":null,"abstract":"<p><strong>Key points: </strong>Current clinical guidelines for glycemic control in patients on peritoneal dialysis lack a strong evidence base. In patients on peritoneal dialysis with diabetes, HbA1c >8% is associated with increased all-cause mortality. Younger patients with less comorbidity have the greatest potential survival benefit with improved glycemic control.</p><p><strong>Background: </strong>Diabetes is the leading cause of kidney failure globally affecting 40% of people receiving peritoneal dialysis (PD). High-quality data on the potential impact of improving glycemic control is needed to inform the current recommendations to individualize HbA 1C targets.</p><p><strong>Methods: </strong>Data from 8 countries in the prospective cohort Peritoneal Dialysis Outcomes and Practice Patterns Study (2014-2022) were used to assess the association between baseline HbA 1C and all-cause mortality in people with type 2 diabetes on PD for at least 90 days. Cox proportional hazards model adjusted for potential confounders was used to assess the relationship in the whole cohort and subgroups. Using inverse probability weighting, an average treatment effect in the treated analysis further investigated potential implications of improved glycemic control.</p><p><strong>Results: </strong>HbA 1C was measured at least once in 8436 patients during a mean follow-up of 16 months. Compared with HbA 1C ≤8% (Diabetes Control and Complications Trial units), HbA 1C >8% was associated with higher risk of all-cause mortality in the cohort as a whole (hazard ratio [HR] 1.18 P = 0.02 95% confidence interval [CI], 1.03 to 1.35) and within subgroups: age younger than 65 years (HR, 1.28; P = 0.01; 95% CI, 1.05 to 1.56), average albumin >3.0 g/dl (HR, 1.25; P = 0.004; 95% CI, 1.07 to 1.46), no preexisting coronary artery disease (CAD; HR, 1.24; P = 0.008; 95% CI, 1.06 to 1.46), hemoglobin <10 g/L (HR, 1.50; P = 0.01; 95% CI, 1.09 to 2.07), and PD vintage <1 year (HR, 1.22; P = 0.02; 95% CI, 1.03 to 1.45). The projected survival advantage at 3 years for those with HbA 1C ≤8% compared with >8% was 7% overall, increasing to 12% in younger cohorts (age younger than 65 years). The largest predicted absolute survival advantage of 16% (78% versus 61%) was seen in those aged younger than 65 years, with a normal serum albumin level and no history of CAD.</p><p><strong>Conclusions: </strong>Associations between HbA 1C and mortality argue for tighter individualized targets for patient subgroups (younger, noninflamed, and without established CAD). Our weighted analysis suggests improved glycemic control (reducing HbA 1C to <8%) may result in an absolute reduction in mortality at 3 years of up to 12% in younger cohorts.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Changes in Kidney Transplantation following Implementation of the Increasing Organ Transplant Access Model.","authors":"Syed Ali Husain, Macey L Levan, Madhur Thakur, Rhiannon D Reed, Jayme E Locke, Samantha A Weiss, Allan B Massie, Dorry L Segev, Darren E Stewart","doi":"10.2215/CJN.0000001225","DOIUrl":"https://doi.org/10.2215/CJN.0000001225","url":null,"abstract":"<p><strong>Background: </strong>The Increasing Organ Transplant Access (IOTA) model is a mandatory experimental payment model that aims to improve kidney transplant access using financial incentives and penalties for transplant centers randomized to model participation, based primarily on growth in transplant volume.</p><p><strong>Methods: </strong>We used national transplant registry data to conduct a retrospective cohort study of US kidney transplant centers. We identified centers randomized to IOTA participation based on the published list of center participants. Using a difference-in-differences approach, we compared IOTA participants to non-participants on changes in overall, deceased donor, and living donor kidney transplant volume per 30 days in the period before IOTA randomization status was announced versus the 9 months following IOTA implementation. Separately among IOTA participants and among non-participants, we compared the proportional change in transplant volume when stratifying centers by pre-IOTA transplant volume, organ offer acceptance rate, and transplant rate ratio.</p><p><strong>Results: </strong>Among 177 included centers, 97 (55%) were IOTA participants and 80 (45%) non-participants. Most IOTA participants (53%) and non-participants (55%) experienced a fall in overall transplant volume after model implementation. However, IOTA participants exhibited a 5% increase in transplant volume per 30 days, whereas non-participants exhibited a 3% decrease (P=0.01). The difference between groups was seen for deceased donor transplants (participants +5% vs. non-participants -9%, P<0.001), while living donor transplants rose in both groups (+7 vs. +19%, P=0.24). Among IOTA participants, there were no statistically significant differences in changes in transplant volume when comparing centers categorized by pre-IOTA transplant volume, organ offer acceptance rate, or transplant rate ratio.</p><p><strong>Conclusions: </strong>Centers randomized to IOTA participation outperformed model non-participants in changes in kidney transplant volume after model implementation, driven by an increase in deceased donor transplant volume among model participants but a fall among non-participants.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed-Methods Study of How Older Adults with Advanced CKD Perceive Kidney Failure Risk.","authors":"Kemberlee Bonnet, Jia H Ng, Paul G Jacob, Fahad Saeed, Jennifer Scherer, Katherine Trapani, Heather Prigmore, Robert Greevy, David Schlundt, Mohana Karlekar, Devika Nair","doi":"10.2215/CJN.0000001220","DOIUrl":"10.2215/CJN.0000001220","url":null,"abstract":"<p><strong>Key points: </strong>Older adults with CKD underestimate their kidney failure risk. Quantitative and qualitative reasons for this included cognitive biases, fatalistic beliefs, and poor clinician communication. Clinicians can use positive language, involve faith leaders, and thoughtfully incorporate prediction models and uremic symptom monitoring.</p><p><strong>Introduction: </strong>Older adults with CKD underestimate their kidney failure risk, which threatens timely dialysis decision making. Cognitive biases are reversible thinking patterns that distort risk perception. We tested how cognitive biases may affect risk perception in CKD and explored participants' risk communication preferences.</p><p><strong>Methods: </strong>We conducted a sequential, explanatory mixed-methods study in adults older than 60 with stage 3B-5 CKD. We quantified objective (Kidney Failure Risk Equation) versus perceived kidney failure risk, cognitive biases (present bias, loss aversion, optimism bias), frailty (Physical Frailty Phenotype), cognition (Montreal Cognitive Assessment), patient activation (Patient Activation Measure-13), depressive symptoms (Quick Inventory of Depressive Symptomatology Self Report-16), and numeracy (Subjective Numeracy Scale). We tested for associations between these factors and concordance between objective versus perceived risk. Participants underestimating objective kidney failure risk were interviewed alongside caregivers.</p><p><strong>Results: </strong>Only 24% of participants reported prognostic concordance. Participants with high objective risk who also perceived their risk as high (concordance) reported more loss aversion than those who perceived their risk as low (88% versus 54%; P < 0.05). In a multivariable model restricted to participants with complete data ( N =167), higher patient activation was independently associated with lower odds of prognostic uncertainty (odds ratio 0.66; 95% confidence interval 0.44 to 0.99). Thirty-eight participants who underestimated their objective risk and 27 caregivers expanded on their cognitive biases, described fatalistic beliefs, and caregiver burnout. Participants described having less prognostic knowledge than caregivers. Participants recommended clinicians use hopeful language, involve caregivers and spiritual leaders in prognostic discussions, acknowledge their numeracy, and apply real-time uremic symptom monitoring to improve risk awareness.</p><p><strong>Conclusions: </strong>Older adults with CKD had discordance between objective and perceived kidney failure risk. Nephrology clinicians can query patients' cognitive biases to examine their impact on risk perception and apply key information delivery methods when communicating kidney failure risk.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Changes in eGFR During Treatment with Balcinrenone and Dapagliflozin: An Exploratory Analysis of the MIRO-CKD Trial.","authors":"Hiddo J L Heerspink, Erika de Sousa-Amorim, Jelle M Beernink, Ozkan Gungor, Anna L Eriksson, Nicolas J Guzman, Yunyun Jiang, Martin Fredholm, Judith Hartleib-Geschwindner, Maria Leonsson-Zachrisson, Patrick B Mark","doi":"10.2215/CJN.0000001202","DOIUrl":"10.2215/CJN.0000001202","url":null,"abstract":"<p><strong>Key points: </strong>Treatment with balcinrenone/dapagliflozin resulted in an acute reduction in eGFR, which was reversible after treatment discontinuation. Larger acute eGFR reductions were associated with greater reductions in urinary albumin-to-creatinine ratio and systolic BP during balcinrenone/dapagliflozin treatment. An acute reduction in eGFR during treatment with balcinrenone/dapagliflozin did not lead to increased rates of adverse events.</p><p><strong>Introduction: </strong>The novel nonsteroidal mineralocorticoid receptor antagonist balcinrenone in combination with dapagliflozin reduced urinary albumin-to-creatinine ratio (UACR) over 12 weeks in the MIRO-CKD phase 2 trial in CKD and induced a modest acute eGFR reduction upon treatment initiation. This prespecified analysis explored the acute eGFR changes in response to balcinrenone/dapagliflozin and the association of these acute eGFR changes on safety and efficacy parameters.</p><p><strong>Methods: </strong>Adults with CKD ( N =324, eGFR ≥25-<60 ml/min per 1.73 m 2 ; UACR ≥100-<5000 mg/g) were randomized to balcinrenone/dapagliflozin 15/10 mg, balcinrenone/dapagliflozin 40/10 mg, or dapagliflozin 10 mg/placebo as adjunct to renin-angiotensin system therapy. The primary outcome was the relative change in UACR from baseline over 12 weeks. Acute eGFR changes 4 weeks post randomization and 4 weeks post treatment were assessed using mixed model repeated measures. We categorized participants according to relative eGFR changes: ≥10% reduction (eGFR dip); >0-<10% reduction; or an eGFR increase. We examined safety and concomitant changes in systolic BP (SBP) and UACR across categories of eGFR changes.</p><p><strong>Results: </strong>Relative to dapagliflozin/placebo, the acute eGFR dip at week 4 with balcinrenone/dapagliflozin 15/10 mg was -0.6 ml/min per 1.73 m 2 (95% confidence interval, -2.4 to 1.1) and with balcinrenone/dapagliflozin 40/10 mg -1.7 ml/min per 1.73 m 2 (95% confidence interval, -3.5 to -0.01). The acute reduction in eGFR with balcinrenone/dapagliflozin was reversible 4 weeks after treatment discontinuation. This finding was consistent across subgroups. In the overall cohort, larger acute eGFR reductions were associated with larger reductions in UACR and SBP across treatment arms. Rates of serious adverse events and adverse events of special interest were low, similar in the balcinrenone/dapagliflozin versus placebo/dapagliflozin group, and unrelated to the acute eGFR change.</p><p><strong>Conclusion: </strong>In adults with CKD, balcinrenone/dapagliflozin induced a modest acute eGFR reduction that was reversible after treatment discontinuation, did not lead to increased rates of adverse events, and was associated with greater SBP and UACR lowering.</p><p><strong>Clinical trial registry name and registration number: </strong>NCT06350123 .</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}