Yizi Gong, Ting Meng, Wei Lin, Xueling Hu, Rong Tang, Qi Xiong, Joshua D Ooi, Peter J Eggenhuizen, Jinbiao Chen, Ya-Ou Zhou, Hui Luo, Jia Xu, Ning Liu, Ping Xiao, Xiangcheng Xiao, Yong Zhong
Background The remission rate of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) patients who received standard induction therapy is far from satisfactory. Improving the remission rate of MPO-AAV patients is essential. Hydroxychloroquine (HCQ), one of the classic antimalarial drugs, has been widely used in various autoimmune rheumatic diseases. This retrospective observational cohort study is aimed to evaluate the efficacy and safety of HCQ during induction treatment for MPO-AAV. Methods The medical records of patients diagnosed with MPO-AAV at Xiangya Hospital, Central South University from January 2021 to September 2023 were collected. They were assigned to the HCQ group or control group according to whether they used HCQ. The patients included were screened by propensity score matching. To evaluate whether MPO-AAV patients benefited from HCQ, we compared the prognosis of the two groups. The adverse effects of HCQ during follow-up were recorded. Results The composition ratio of complete remission, response and treatment resistance between HCQ group and control group were different statistically (P = 0.021). There was no significant difference between the two groups in one-year renal survival (P = 0.789). The HCQ group had better one-year patient survival than the control group (P = 0.049). No serious adverse effects were documented in the HCQ group. Conclusions HCQ together with standard induction treatment may improve the remission rate of MPO-AAV patients, and HCQ has good safety in our study.
{"title":"Hydroxychloroquine as an add-on therapy for the induction therapy of MPO-AAV: a retrospective observational cohort study","authors":"Yizi Gong, Ting Meng, Wei Lin, Xueling Hu, Rong Tang, Qi Xiong, Joshua D Ooi, Peter J Eggenhuizen, Jinbiao Chen, Ya-Ou Zhou, Hui Luo, Jia Xu, Ning Liu, Ping Xiao, Xiangcheng Xiao, Yong Zhong","doi":"10.1093/ckj/sfae264","DOIUrl":"https://doi.org/10.1093/ckj/sfae264","url":null,"abstract":"Background The remission rate of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) patients who received standard induction therapy is far from satisfactory. Improving the remission rate of MPO-AAV patients is essential. Hydroxychloroquine (HCQ), one of the classic antimalarial drugs, has been widely used in various autoimmune rheumatic diseases. This retrospective observational cohort study is aimed to evaluate the efficacy and safety of HCQ during induction treatment for MPO-AAV. Methods The medical records of patients diagnosed with MPO-AAV at Xiangya Hospital, Central South University from January 2021 to September 2023 were collected. They were assigned to the HCQ group or control group according to whether they used HCQ. The patients included were screened by propensity score matching. To evaluate whether MPO-AAV patients benefited from HCQ, we compared the prognosis of the two groups. The adverse effects of HCQ during follow-up were recorded. Results The composition ratio of complete remission, response and treatment resistance between HCQ group and control group were different statistically (P = 0.021). There was no significant difference between the two groups in one-year renal survival (P = 0.789). The HCQ group had better one-year patient survival than the control group (P = 0.049). No serious adverse effects were documented in the HCQ group. Conclusions HCQ together with standard induction treatment may improve the remission rate of MPO-AAV patients, and HCQ has good safety in our study.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"67 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Florent Guerville, Marion Pépin, Antoine Garnier-Crussard, Jean-Baptiste Beuscart, Salvatore Citarda, Aldjia Hocine, Cédric Villain, Thomas Tannou
Improving care for older people with end-stage kidney disease (ESKD) requires standards to be adapted to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline, and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to: (1) describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; (2) apply these concepts to the context of ESKD; (3) identify components and modalities of shared decision-making, and (4) suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.
{"title":"How to make a shared decision with older persons for end-stage kidney disease treatment? The added value of geronto-nephrology","authors":"Florent Guerville, Marion Pépin, Antoine Garnier-Crussard, Jean-Baptiste Beuscart, Salvatore Citarda, Aldjia Hocine, Cédric Villain, Thomas Tannou","doi":"10.1093/ckj/sfae281","DOIUrl":"https://doi.org/10.1093/ckj/sfae281","url":null,"abstract":"Improving care for older people with end-stage kidney disease (ESKD) requires standards to be adapted to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline, and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to: (1) describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; (2) apply these concepts to the context of ESKD; (3) identify components and modalities of shared decision-making, and (4) suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"190 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hicham I Cheikh Hassan, Bridie S Mulholland, Brendan McAlister, Kelly Lambert, Karumathil M Murali, Stephen Moules, Judy Mullan
Background Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear if an AKI episode is associated with the risk of bone fractures. Methods Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity. Results Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88- 2.11]. This association persisted in the adjusted analysis (HR 1.50, 95%CI 1.41- 1.59) and propensity matched dataset (HR 1.71, 95%CI 1.59- 1.83). The sensitivity analysis yielded similar results with the AKI patients having a higher risk of fractures compared to no AKI patients in the adjusted analysis (HR 1.34, 95%CI 1.25- 1.43) and in the propensity matched dataset (HR 1.44, 95%CI 1.33- 1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (P = 0.7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis. Conclusions AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post AKI episode. This association should be examined in other cohorts and populations for verification.
背景 急性肾损伤（AKI）很常见。急性肾损伤可能会破坏由正常肾功能维持的正常矿物质骨平衡，从而改变发生骨折的风险。然而，目前仍不清楚急性肾损伤是否与骨折风险有关。方法 我们利用澳大利亚一个地方卫生区的回顾性队列研究，使用 2008 年至 2017 年期间的患者数据，研究了 AKI 事件与骨折之间的关联。我们采用了时变考克斯比例危害分析和倾向匹配分析来研究两者之间的关系。进行了敏感性分析，以了解确诊的 AKI 状态和 AKI 严重程度的影响。结果 在纳入的 123 426 例患者中，14 549 例（12%）发生过 AKI，12 505 例（10%）发生过骨折。在未经调整的分析中，AKI 与骨折有关[危险比 (HR) 1.99，95% 置信区间 (CI) 1.88-2.11]。在调整分析（HR 1.50，95% 置信区间 1.41-1.59）和倾向匹配数据集（HR 1.71，95% 置信区间 1.59-1.83）中，这种关联依然存在。敏感性分析得出了类似的结果，在调整分析（HR 1.34，95%CI 1.25-1.43）和倾向匹配数据集（HR 1.44，95%CI 1.33-1.55）中，与无 AKI 患者相比，AKI 患者的骨折风险更高。在排除无基线肌酐的患者的辅助敏感性分析中也发现了类似的结果。我们没有发现骨折风险随着 AKI 严重程度的增加而增加（P = 0.7）。交互测试表明，性别和年龄类别与 AKI 状态和骨折有显著关联，但与 CKD 分期或骨质疏松症无关。结论 AKI 与更高的骨折风险相关。这可能会对管理和筛查 AKI 后患者的骨病产生影响。这种关联应在其他队列和人群中进行研究以验证。
{"title":"Associations between acute kidney injury and bone fractures: a retrospective cohort study","authors":"Hicham I Cheikh Hassan, Bridie S Mulholland, Brendan McAlister, Kelly Lambert, Karumathil M Murali, Stephen Moules, Judy Mullan","doi":"10.1093/ckj/sfae282","DOIUrl":"https://doi.org/10.1093/ckj/sfae282","url":null,"abstract":"Background Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear if an AKI episode is associated with the risk of bone fractures. Methods Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity. Results Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88- 2.11]. This association persisted in the adjusted analysis (HR 1.50, 95%CI 1.41- 1.59) and propensity matched dataset (HR 1.71, 95%CI 1.59- 1.83). The sensitivity analysis yielded similar results with the AKI patients having a higher risk of fractures compared to no AKI patients in the adjusted analysis (HR 1.34, 95%CI 1.25- 1.43) and in the propensity matched dataset (HR 1.44, 95%CI 1.33- 1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (P = 0.7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis. Conclusions AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post AKI episode. This association should be examined in other cohorts and populations for verification.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"47 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Murilo Guedes, Charlotte Tu, Nidhi Sukul, Elham Asgari, Fitsum Guebre-Egziabher, Despina Ruessmann, Thilo Schaufler, Hugh Rayner, Michel Jadoul, Laura Labriola, Roberto Pecoits-Filho, Ronald L Pisoni, Angelo Karaboyas
Background and Hypothesis The associations between self-reported chronic kidney disease-associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–2023. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: average and worst itching intensity numerical rating scales (AI-NRS, WI-NRS) and a KDQOL-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden, and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1, and 3.1 for extremely, very much, moderately, and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Discussion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs. the AI- and WI-NRS (24 hours). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.
{"title":"Chronic kidney disease-associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient reported outcome survey in Europe","authors":"Murilo Guedes, Charlotte Tu, Nidhi Sukul, Elham Asgari, Fitsum Guebre-Egziabher, Despina Ruessmann, Thilo Schaufler, Hugh Rayner, Michel Jadoul, Laura Labriola, Roberto Pecoits-Filho, Ronald L Pisoni, Angelo Karaboyas","doi":"10.1093/ckj/sfae276","DOIUrl":"https://doi.org/10.1093/ckj/sfae276","url":null,"abstract":"Background and Hypothesis The associations between self-reported chronic kidney disease-associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–2023. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: average and worst itching intensity numerical rating scales (AI-NRS, WI-NRS) and a KDQOL-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden, and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1, and 3.1 for extremely, very much, moderately, and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Discussion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs. the AI- and WI-NRS (24 hours). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"10 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Matyjek, Stanisław Niemczyk, Sławomir Literacki, Wojciech Fendler, Tomasz Rozmysłowicz, Andreas Kronbichler
Background Nephrotic syndrome (NS) is characterized by urinary loss of proteins, including hormones and their carrier proteins, potentially resulting in endocrine disorders. This study aimed to assess thyroid dysfunction frequency and potential implications in NS. Methods In this case-control study, patients with severe NS (serum albumin ≤ 2.5 g/dL) and controls without proteinuria were evaluated for thyroid, hemostatic, and nutritional parameters, including body composition. Results Forty-two nephrotic and 40 non-proteinuric patients were enrolled. The NS group showed higher thyroid-stimulating hormone and lower free hormones, corresponding to a higher frequency of both euthyroid sick syndrome (ESS; 36% vs 5%; OR = 10.6, 95%CI: 2.2–50.0), and hypothyroidism (31% vs 5%; OR = 8.5, 95%CI: 1.8–40.7) compared to the control group. Levothyroxine supplementation was required for 11 NS patients (26% of the NS group). In addition, in comparison to the control individuals, NS patients exhibited lower lean tissue mass and a trend towards hypercoagulability, which was evidenced by higher levels of most coagulation factors and fibrinolysis inhibitors, and reduced endogenous anticoagulants activities. Furthermore, NS patients with ESS presented with a 10.4 kg (95% CI: −18.68 to −2.12) lower lean tissue mass. Those with hypothyroidism had a significantly reduced activity of coagulation factor X (by −30%, 95%CI: −47 to −13) and protein S (by −27%, 95%CI: −41 to −13) compared to euthyroid NS individuals. Conclusions Thyroid dysfunction is common in severe NS, often necessitating levothyroxine supplementation, which supports routine thyroid workup. A potential link between thyroid, nutritional, and coagulation disorders in NS requires further investigation.
{"title":"The impact of severe nephrotic syndrome on thyroid function, nutrition and coagulation","authors":"Anna Matyjek, Stanisław Niemczyk, Sławomir Literacki, Wojciech Fendler, Tomasz Rozmysłowicz, Andreas Kronbichler","doi":"10.1093/ckj/sfae280","DOIUrl":"https://doi.org/10.1093/ckj/sfae280","url":null,"abstract":"Background Nephrotic syndrome (NS) is characterized by urinary loss of proteins, including hormones and their carrier proteins, potentially resulting in endocrine disorders. This study aimed to assess thyroid dysfunction frequency and potential implications in NS. Methods In this case-control study, patients with severe NS (serum albumin ≤ 2.5 g/dL) and controls without proteinuria were evaluated for thyroid, hemostatic, and nutritional parameters, including body composition. Results Forty-two nephrotic and 40 non-proteinuric patients were enrolled. The NS group showed higher thyroid-stimulating hormone and lower free hormones, corresponding to a higher frequency of both euthyroid sick syndrome (ESS; 36% vs 5%; OR = 10.6, 95%CI: 2.2–50.0), and hypothyroidism (31% vs 5%; OR = 8.5, 95%CI: 1.8–40.7) compared to the control group. Levothyroxine supplementation was required for 11 NS patients (26% of the NS group). In addition, in comparison to the control individuals, NS patients exhibited lower lean tissue mass and a trend towards hypercoagulability, which was evidenced by higher levels of most coagulation factors and fibrinolysis inhibitors, and reduced endogenous anticoagulants activities. Furthermore, NS patients with ESS presented with a 10.4 kg (95% CI: −18.68 to −2.12) lower lean tissue mass. Those with hypothyroidism had a significantly reduced activity of coagulation factor X (by −30%, 95%CI: −47 to −13) and protein S (by −27%, 95%CI: −41 to −13) compared to euthyroid NS individuals. Conclusions Thyroid dysfunction is common in severe NS, often necessitating levothyroxine supplementation, which supports routine thyroid workup. A potential link between thyroid, nutritional, and coagulation disorders in NS requires further investigation.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"68 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philipp Tessmer, Clara A Weigle, Anna Meyer, Bengt A Wiemann, Wilfried Gwinner, Gunilla Einecke, Jürgen Klempnauer, Florian W R Vondran, Nicolas Richter, Felix Oldhafer, Oliver Beetz
Background Compared to primary transplantation, ipsilateral renal re-transplantation is associated with an increased risk of surgical complications and inferior graft outcomes. This study investigates whether an ipsilateral re-transplantation approach per se is an independent risk factor for surgical complications and early graft loss. Methods In this retrospective, single-centre analysis, surgical complications and early graft outcomes of ipsilateral kidney re-transplantations from January 2007 to December 2017 were compared with primary transplantations and contralateral re-transplantations. Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for surgical complications requiring surgical revision and graft loss within the first year after transplantation. Results Of the 1.489 kidney transplantations, 51 were ipsilateral, 159 were contralateral re-transplantations, and 1.279 were primary transplantations. Baseline characteristics did not differ between the ipsilateral and contralateral re-transplant recipients except for current and highest PRA levels. Major complications requiring surgical revision were significantly more frequent in ipsilateral re-transplantations (P = 0.010) than in primary transplantations but did not differ between ipsilateral and contralateral re-transplantations (P = 0.217). Graft loss within the first year after transplant was 15.7% in the ipsilateral versus 8.8% in the contralateral re-transplant group (P = 0.163) versus 6.4% in the primary transplantation group (P = 0.009). In a multivariate regression model, ipsilateral re-transplantation was not identified as an independent risk factor for complications requiring surgical revision or first-year graft loss. Conclusions Ipsilateral renal re-transplantation is no risk factor for inferior outcomes. Graft implantation into a pre-transplanted iliac fossa is a feasible and valid therapeutic option.
{"title":"Kidney re-transplantation in the ipsilateral iliac fossa: a surgeon's perspective on perioperative outcome","authors":"Philipp Tessmer, Clara A Weigle, Anna Meyer, Bengt A Wiemann, Wilfried Gwinner, Gunilla Einecke, Jürgen Klempnauer, Florian W R Vondran, Nicolas Richter, Felix Oldhafer, Oliver Beetz","doi":"10.1093/ckj/sfae271","DOIUrl":"https://doi.org/10.1093/ckj/sfae271","url":null,"abstract":"Background Compared to primary transplantation, ipsilateral renal re-transplantation is associated with an increased risk of surgical complications and inferior graft outcomes. This study investigates whether an ipsilateral re-transplantation approach per se is an independent risk factor for surgical complications and early graft loss. Methods In this retrospective, single-centre analysis, surgical complications and early graft outcomes of ipsilateral kidney re-transplantations from January 2007 to December 2017 were compared with primary transplantations and contralateral re-transplantations. Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for surgical complications requiring surgical revision and graft loss within the first year after transplantation. Results Of the 1.489 kidney transplantations, 51 were ipsilateral, 159 were contralateral re-transplantations, and 1.279 were primary transplantations. Baseline characteristics did not differ between the ipsilateral and contralateral re-transplant recipients except for current and highest PRA levels. Major complications requiring surgical revision were significantly more frequent in ipsilateral re-transplantations (P = 0.010) than in primary transplantations but did not differ between ipsilateral and contralateral re-transplantations (P = 0.217). Graft loss within the first year after transplant was 15.7% in the ipsilateral versus 8.8% in the contralateral re-transplant group (P = 0.163) versus 6.4% in the primary transplantation group (P = 0.009). In a multivariate regression model, ipsilateral re-transplantation was not identified as an independent risk factor for complications requiring surgical revision or first-year graft loss. Conclusions Ipsilateral renal re-transplantation is no risk factor for inferior outcomes. Graft implantation into a pre-transplanted iliac fossa is a feasible and valid therapeutic option.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"26 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03eCollection Date: 2024-10-01DOI: 10.1093/ckj/sfae273
Victoria J Riehl-Tonn, Jennifer M MacRae, Sandra M Dumanski, Meghan J Elliott, Neesh Pannu, Kara Schick-Makaroff, Kelsea Drall, Colleen Norris, Kara A Nerenberg, Louise Pilote, Hassan Behlouli, Taryn Gantar, Sofia B Ahmed
Background: Women treated with hemodialysis report lower health-related quality of life (HRQoL) compared with men. Whether this is related to sex-specific (biological) (e.g. under-dialysis due to body composition differences) or gender-specific (sociocultural) factors (e.g. greater domestic/caregiver responsibilities for women) is unknown. We examined the association between sex assigned at birth, gender score and HRQoL in individuals initiating conventional and incremental hemodialysis.
Methods: In this prospective multi-center cohort study, incident adult hemodialysis patients were recruited between 1 June 2020 and 30 April 2022 in Alberta, Canada. Sex assigned at birth and gender identity were self-reported. Gender-related characteristics were assessed by self-administered questionnaire to derive a composite measure of gender. The primary outcome was change in Kidney Disease Quality of Life 36 physical (PCS) and mental (MCS) component scores after 3 months of hemodialysis.
Results: Sixty participants were enrolled (conventional hemodialysis: 14 female, 19 male; incremental hemodialysis: 12 female, 15 male). PCS improved from baseline with conventional (P = .01) but not incremental (P = .52) hemodialysis in female participants. No difference in MCS was observed by hemodialysis type in female participants. Gender score was not associated with changes in PCS in female participants, irrespective of hemodialysis type. Higher gender score was associated with increased MCS with incremental (P = .04), but not conventional (P = .14), hemodialysis (P = .03 conventional vs incremental) in female participants. No change in PCS or MCS was seen in male participants, irrespective of hemodialysis type or gender score.
Conclusion: In this exploratory study, conventional hemodialysis was associated with improved PCS in female participants, while incremental hemodialysis was associated with improved MCS in female participants with more roles and responsibilities traditionally ascribed to women. Large prospective studies are required to further investigate these relationships.
{"title":"Sex and gender differences in health-related quality of life in individuals treated with incremental and conventional hemodialysis.","authors":"Victoria J Riehl-Tonn, Jennifer M MacRae, Sandra M Dumanski, Meghan J Elliott, Neesh Pannu, Kara Schick-Makaroff, Kelsea Drall, Colleen Norris, Kara A Nerenberg, Louise Pilote, Hassan Behlouli, Taryn Gantar, Sofia B Ahmed","doi":"10.1093/ckj/sfae273","DOIUrl":"https://doi.org/10.1093/ckj/sfae273","url":null,"abstract":"<p><strong>Background: </strong>Women treated with hemodialysis report lower health-related quality of life (HRQoL) compared with men. Whether this is related to sex-specific (biological) (e.g. under-dialysis due to body composition differences) or gender-specific (sociocultural) factors (e.g. greater domestic/caregiver responsibilities for women) is unknown. We examined the association between sex assigned at birth, gender score and HRQoL in individuals initiating conventional and incremental hemodialysis.</p><p><strong>Methods: </strong>In this prospective multi-center cohort study, incident adult hemodialysis patients were recruited between 1 June 2020 and 30 April 2022 in Alberta, Canada. Sex assigned at birth and gender identity were self-reported. Gender-related characteristics were assessed by self-administered questionnaire to derive a composite measure of gender. The primary outcome was change in Kidney Disease Quality of Life 36 physical (PCS) and mental (MCS) component scores after 3 months of hemodialysis.</p><p><strong>Results: </strong>Sixty participants were enrolled (conventional hemodialysis: 14 female, 19 male; incremental hemodialysis: 12 female, 15 male). PCS improved from baseline with conventional (<i>P </i>= .01) but not incremental (<i>P </i>= .52) hemodialysis in female participants. No difference in MCS was observed by hemodialysis type in female participants. Gender score was not associated with changes in PCS in female participants, irrespective of hemodialysis type. Higher gender score was associated with increased MCS with incremental (<i>P </i>= .04), but not conventional (<i>P </i>= .14), hemodialysis (<i>P </i>= .03 conventional vs incremental) in female participants. No change in PCS or MCS was seen in male participants, irrespective of hemodialysis type or gender score.</p><p><strong>Conclusion: </strong>In this exploratory study, conventional hemodialysis was associated with improved PCS in female participants, while incremental hemodialysis was associated with improved MCS in female participants with more roles and responsibilities traditionally ascribed to women. Large prospective studies are required to further investigate these relationships.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae273"},"PeriodicalIF":3.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janosch Niknam, Sebastian Mussnig, Christoph Matthias, Maximilian Waller, Nikolaus Keil, Simon Krenn, Joachim Beige, Daniel Schneditz, Manfred Hecking
Introduction Hemodialysis relies on accurate body mass (BM) assessment to determine ultrafiltration volumes, but we have not identified published practice patterns, disclosing how to handle clothing mass. Here we investigated the potential impact of clothing mass on predialysis BM determination, hypothesizing that a standardized template for clothing mass estimation enhances accuracy, compared to conventional practice. Methods Measurements included dressed and undressed BM predialysis. A pre-established template for average clothing mass was used to approximate undressed BM from clothed measurements. Differences to undressed BM were compared using Bland-Altman plots and tested for statistical significance using Wilcoxon signed rank tests. Results After excluding erroneous results, data from 48 patients were analyzed. Thirty-six patients (75%) did not habitually estimate clothing mass, but used their dressed BM as the predialysis BM, while the other 12 patients (25%) reported deducting a self-estimated clothing mass from their clothed predialysis BM. The differences to undressed BM were 0.819 ± 0.462 kg and 0.342 ± 0.321 kg in these two groups, respectively, indicating that patients underestimated clothing mass. Using the template to deduct clothing mass from clothed predialysis BM, these differences could be reduced to 0.197 ± 0.220 kg and 0.133 ± 0.135 kg, respectively. The average differences using the patient-reported BM and the template-based BM made up 39.4% and 8.6% of the average, subsequent ultrafiltration volume, respectively, suggesting that potential overestimation of the actual ultrafiltration volume could be reduced. Conclusion A standardized template for clothing mass may be useful to derive representative predialysis BM, leading to more precise ultrafiltration calculation. Exact BM determination might improve volume management in hemodialysis.
{"title":"The weighing process in patients on hemodialysis: an opportunity to improve volume management","authors":"Janosch Niknam, Sebastian Mussnig, Christoph Matthias, Maximilian Waller, Nikolaus Keil, Simon Krenn, Joachim Beige, Daniel Schneditz, Manfred Hecking","doi":"10.1093/ckj/sfae275","DOIUrl":"https://doi.org/10.1093/ckj/sfae275","url":null,"abstract":"Introduction Hemodialysis relies on accurate body mass (BM) assessment to determine ultrafiltration volumes, but we have not identified published practice patterns, disclosing how to handle clothing mass. Here we investigated the potential impact of clothing mass on predialysis BM determination, hypothesizing that a standardized template for clothing mass estimation enhances accuracy, compared to conventional practice. Methods Measurements included dressed and undressed BM predialysis. A pre-established template for average clothing mass was used to approximate undressed BM from clothed measurements. Differences to undressed BM were compared using Bland-Altman plots and tested for statistical significance using Wilcoxon signed rank tests. Results After excluding erroneous results, data from 48 patients were analyzed. Thirty-six patients (75%) did not habitually estimate clothing mass, but used their dressed BM as the predialysis BM, while the other 12 patients (25%) reported deducting a self-estimated clothing mass from their clothed predialysis BM. The differences to undressed BM were 0.819 ± 0.462 kg and 0.342 ± 0.321 kg in these two groups, respectively, indicating that patients underestimated clothing mass. Using the template to deduct clothing mass from clothed predialysis BM, these differences could be reduced to 0.197 ± 0.220 kg and 0.133 ± 0.135 kg, respectively. The average differences using the patient-reported BM and the template-based BM made up 39.4% and 8.6% of the average, subsequent ultrafiltration volume, respectively, suggesting that potential overestimation of the actual ultrafiltration volume could be reduced. Conclusion A standardized template for clothing mass may be useful to derive representative predialysis BM, leading to more precise ultrafiltration calculation. Exact BM determination might improve volume management in hemodialysis.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"77 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiao Xu, Zhiyuan Xu, Tiantian Ma, Shaomei Li, Huayi Pei, Jinghong Zhao, Ying Zhang, Zibo Xiong, Yumei Liao, Ying Li, Qiongzhen Lin, Wenbo Hu, Yulin Li, Zhaoxia Zheng, Liping Duan, Gang Fu, Shanshan Guo, Beiru Zhang, Rui Yu, Fuyun Sun, Xiaoying Ma, Li Hao, Guiling Liu, Zhanzheng Zhao, Jing Xiao, Yulan Shen, Yong Zhang, Xuanyi Du, Tianrong Ji, Caili Wang, Lirong Deng, Yingli Yue, Shanshan Chen, Zhigang Ma, Yingping Li, Li Zuo, Huiping Zhao, Xianchao Zhang, Xuejian Wang, Yirong Liu, Xinying Gao, Xiaoli Chen, Hongyi Li, Shutong Du, Cui Zhao, Zhonggao Xu, Li Zhang, Hongyu Chen, Li Li, Lihua Wang, Yan Yan, Yingchun Ma, Yuanyuan Wei, Jingwei Zhou, Yan Li, Jie Dong, Kai Niu, Zhiqiang He
Although more and more cardiovascular risk factors have been verified in peritoneal dialysis (PD) populations in different countries and regions, it is still difficult for clinicians to accurately and individually predict death in the near future. We aimed to develop and validate machine learning-based models to predict near-term all-cause and cardiovascular death. Machine learning models were developed among 7539 PD patients, which were randomly divided into a training set and an internal test set by 5 random shuffles of 5-fold cross-validation, to predict the cardiovascular death and all-cause death in 3 months. We chose objectively-collected markers such as patient demographics, clinical characteristics, laboratory data and dialysis-related variables to inform the models and assessed the predictive performance using a range of common performance metrics, such as sensitivity, positive predictive values (PPV), the area under the receiver operating curve (AUROC) and the area under the precision recall curve (AUPRC). In the test set, the CVDformer models had a AUROC of 0.8767 (0.8129, 0.9045) and 0.9026 (0.8404, 0.9352) and AUPRC of 0.9338 (0.8134,0.9453) and 0.9073 (0.8412,0.9164) in predicting near-term all-cause death and cardiovascular death, respectively. The CVDformer models had high sensitivity and PPV for predicting all-cause and cardiovascular deaths in 3 months in our PD population. Further calibration is warranted in the future.
{"title":"Machine learning for identification of short-term all-cause and cardiovascular deaths among patients undergoing peritoneal dialysis patients","authors":"Xiao Xu, Zhiyuan Xu, Tiantian Ma, Shaomei Li, Huayi Pei, Jinghong Zhao, Ying Zhang, Zibo Xiong, Yumei Liao, Ying Li, Qiongzhen Lin, Wenbo Hu, Yulin Li, Zhaoxia Zheng, Liping Duan, Gang Fu, Shanshan Guo, Beiru Zhang, Rui Yu, Fuyun Sun, Xiaoying Ma, Li Hao, Guiling Liu, Zhanzheng Zhao, Jing Xiao, Yulan Shen, Yong Zhang, Xuanyi Du, Tianrong Ji, Caili Wang, Lirong Deng, Yingli Yue, Shanshan Chen, Zhigang Ma, Yingping Li, Li Zuo, Huiping Zhao, Xianchao Zhang, Xuejian Wang, Yirong Liu, Xinying Gao, Xiaoli Chen, Hongyi Li, Shutong Du, Cui Zhao, Zhonggao Xu, Li Zhang, Hongyu Chen, Li Li, Lihua Wang, Yan Yan, Yingchun Ma, Yuanyuan Wei, Jingwei Zhou, Yan Li, Jie Dong, Kai Niu, Zhiqiang He","doi":"10.1093/ckj/sfae242","DOIUrl":"https://doi.org/10.1093/ckj/sfae242","url":null,"abstract":"Although more and more cardiovascular risk factors have been verified in peritoneal dialysis (PD) populations in different countries and regions, it is still difficult for clinicians to accurately and individually predict death in the near future. We aimed to develop and validate machine learning-based models to predict near-term all-cause and cardiovascular death. Machine learning models were developed among 7539 PD patients, which were randomly divided into a training set and an internal test set by 5 random shuffles of 5-fold cross-validation, to predict the cardiovascular death and all-cause death in 3 months. We chose objectively-collected markers such as patient demographics, clinical characteristics, laboratory data and dialysis-related variables to inform the models and assessed the predictive performance using a range of common performance metrics, such as sensitivity, positive predictive values (PPV), the area under the receiver operating curve (AUROC) and the area under the precision recall curve (AUPRC). In the test set, the CVDformer models had a AUROC of 0.8767 (0.8129, 0.9045) and 0.9026 (0.8404, 0.9352) and AUPRC of 0.9338 (0.8134,0.9453) and 0.9073 (0.8412,0.9164) in predicting near-term all-cause death and cardiovascular death, respectively. The CVDformer models had high sensitivity and PPV for predicting all-cause and cardiovascular deaths in 3 months in our PD population. Further calibration is warranted in the future.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"9 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastian Spencer, Robert Desborough, Samir Mehta, Natalie Ives, Sunil Bhandari
Background and hypothesis In this secondary analysis of the STOP-ACEi trial, we explored the impact of discontinuing or continuing renin angiotensin system inhibitor therapy in people with advanced chronic kidney disease on cystatin C estimated glomerular filtration rate. Methods Cystatin C eGFR were calculated at baseline, 12-, 24- and 36-months using CKD-EPI Cystatin 2012, EKFC and CKD-EPI Combined 2021 equations. We excluded samples obtained after the initiation of kidney-replacement therapy. Primary analysis used complete case analysis and mixed-effects linear regression model, adjusting for minimization variables, baseline value, time-point, and treatment by time interaction. Sensitivity analysis was conducted using a pattern mixture model to account for missing data that was not at random. To model the longitudinal cystatin C data with time-to-event data, a joint model was utilized which incorporated the cystatin C measurements at various time points and accounted for the occurrence of kidney replacement therapy. Results The mean cystatin C eGFR (CKD-EPI 2012) at baseline were 17.8 mg/L [SD: 6.3] and 17.9 ml/min/1.73m2 [SD: 6.3] in the STOP and CONTINUE arms respectively. The estimated least squares mean difference at 12 months between STOP and CONTINUE arm was -1.46 (95% CI: -2.39 to -0.52, p=0.002). The estimated least squares mean difference at 24 months was -2.27 (95% CI: -3.48 to -1.06, p<0.001). The estimated least squares mean difference at 36 months was -1.72 (95% CI: -3.48 to 0.03, p=0.05). Conclusion Our results are consistent with the primary study's analysis and sensitivity analyses support these findings and provide additional insights. Our findings demonstrate the similarity of creatinine and cystatin eGFR results and therefore support the use of cystatin C as an alternative marker of eGFR in advanced CKD, particularly in those whom creatinine is likely to be less accurate.
背景与假设 在这项 STOP-ACEi 试验的二次分析中，我们探讨了晚期慢性肾脏病患者停止或继续肾素血管紧张素系统抑制剂治疗对胱抑素 C 估计肾小球滤过率的影响。方法 使用 CKD-EPI Cystatin 2012、EKFC 和 CKD-EPI Combined 2021 方程计算基线、12、24 和 36 个月的胱抑素 C eGFR。我们排除了开始肾脏替代疗法后获得的样本。初步分析采用了完整病例分析和混合效应线性回归模型，并对最小化变量、基线值、时间点和治疗与时间的交互作用进行了调整。使用模式混合模型进行了敏感性分析，以考虑非随机缺失数据。为了将纵向胱抑素 C 数据与时间到事件数据进行建模，使用了一个联合模型，该模型纳入了不同时间点的胱抑素 C 测量值，并考虑了肾脏替代疗法的发生情况。结果 停止治疗组和继续治疗组基线时的胱抑素 C eGFR（CKD-EPI 2012）平均值分别为 17.8 mg/L [SD: 6.3] 和 17.9 ml/min/1.73m2 [SD: 6.3]。STOP 和 CONTINUE 两组在 12 个月时的估计最小二乘法均值差异为-1.46（95% CI：-2.39 至-0.52，P=0.002）。24 个月时的估计最小二乘法平均差为-2.27（95% CI：-3.48 至-1.06，p<0.001）。36 个月时的估计最小二乘法平均差为-1.72（95% CI：-3.48 至 0.03，p=0.05）。结论 我们的结果与主要研究的分析一致，敏感性分析支持这些发现，并提供了更多的见解。我们的研究结果证明了肌酐和胱抑素 eGFR 结果的相似性，因此支持使用胱抑素 C 作为晚期 CKD 患者 eGFR 的替代指标，尤其是肌酐可能不太准确的患者。
{"title":"Cystatin C vs Creatinine eGFR in Advanced CKD: an analysis of the STOP-ACEi Trial","authors":"Sebastian Spencer, Robert Desborough, Samir Mehta, Natalie Ives, Sunil Bhandari","doi":"10.1093/ckj/sfae268","DOIUrl":"https://doi.org/10.1093/ckj/sfae268","url":null,"abstract":"Background and hypothesis In this secondary analysis of the STOP-ACEi trial, we explored the impact of discontinuing or continuing renin angiotensin system inhibitor therapy in people with advanced chronic kidney disease on cystatin C estimated glomerular filtration rate. Methods Cystatin C eGFR were calculated at baseline, 12-, 24- and 36-months using CKD-EPI Cystatin 2012, EKFC and CKD-EPI Combined 2021 equations. We excluded samples obtained after the initiation of kidney-replacement therapy. Primary analysis used complete case analysis and mixed-effects linear regression model, adjusting for minimization variables, baseline value, time-point, and treatment by time interaction. Sensitivity analysis was conducted using a pattern mixture model to account for missing data that was not at random. To model the longitudinal cystatin C data with time-to-event data, a joint model was utilized which incorporated the cystatin C measurements at various time points and accounted for the occurrence of kidney replacement therapy. Results The mean cystatin C eGFR (CKD-EPI 2012) at baseline were 17.8 mg/L [SD: 6.3] and 17.9 ml/min/1.73m2 [SD: 6.3] in the STOP and CONTINUE arms respectively. The estimated least squares mean difference at 12 months between STOP and CONTINUE arm was -1.46 (95% CI: -2.39 to -0.52, p=0.002). The estimated least squares mean difference at 24 months was -2.27 (95% CI: -3.48 to -1.06, p&lt;0.001). The estimated least squares mean difference at 36 months was -1.72 (95% CI: -3.48 to 0.03, p=0.05). Conclusion Our results are consistent with the primary study's analysis and sensitivity analyses support these findings and provide additional insights. Our findings demonstrate the similarity of creatinine and cystatin eGFR results and therefore support the use of cystatin C as an alternative marker of eGFR in advanced CKD, particularly in those whom creatinine is likely to be less accurate.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"3 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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