Family based behavioral treatment in adolescents suffering from obesity: evolution through adulthood.

BACKGROUND: Family Based Behavioral Treatments (FBBT) are reported to have a favorable impact on the short and mid-term evolution on the body mass index (BMI) of adolescents suffering from obesity. This study investigated the long-term BMI z-score evolution, as well as variables associated with favorable or unfavorable evolution in adolescents who beneficiated from FBBT group therapy treatment for obesity. METHODS: This was a prospective study including adolescents who participated in FBBT group therapy for obesity sessions (n = 131). All adolescents were invited for a study's clinical interview 4 years after the therapy, during which their weight and height were measured, and they answered a questionnaire on some life habits. Anthropometric measurements at the time of therapy as well as socio-demographic data were retrospectively extracted from the electronic medical record. RESULTS: Seventy-six subjects (57% of the sample) accepted to participate in the study. At the study's clinical interview (mean 5.5 years after FBBT), 52.6% of the adolescents showed a favorable evolution of their weight status defined as a decrease (>-0.2) or stabilization (between - 0.2 and + 0.2) of their BMI z-score. 32% were engaged in a daily physical activity and 40.6% monitored their weight at least once a week or more. Only these 2 variables were associated with a favorable evolution (p = 0.009 and p = 0.001, respectively). Less than half of the sample (45.9%) have maintained a medical weight-management follow up, of which 67% had a BMI equal or more than 30. CONCLUSIONS: Long-term evolution of the BMI z-score was favorable for most of the adolescents, emphasizing the potential benefits of FBBT treatment on the long term for adolescents suffering from obesity. This study highlighted the difficulty for long-term weight management follow up in this population at risk of numerous medical comorbidities, confirming the need to improve adherence to weight management treatment at this age of transition of care. Prospective observational study registered.

[Attention deficit disorder with/without hyperactivity and obesity in adolescence]. / Trouble du déficit de l'attention avec/ou sans hyperactivité et obésité à l'adolescence.

Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. ADHD is also frequently associated with obesity. Epidemiological studies that have strongly suggested a causal relationship between ADHD and obesity, underscoring the importance of clarifying the underlying pathophysiological mechanisms. An important focus has been the link between ADHD-related impulsivity and obesity, potentially mediated by impulsive eating behavior. Studies suggest that targeting the impulsive dimension of ADHD significantly reduces the risk of obesity. ADHD detection and treatment in children, adolescents and adults is important in terms of prevention and managing of obesity across the lifespan.

Le trouble déficitaire de l'attention avec hyperactivité (TDAH) est un trouble neuropsychiatrique prévalent lié à une déficience et à une détresse significative tout au long de la vie. Il est également fréquemment associé à l'obésité, des études épidémiologiques ayant prouvé une relation de cause à effet. Le lien entre l'impulsivité liée au TDAH et l'obésité a fait l'objet d'une attention particulière. Des études suggèrent que le fait de cibler la dimension impulsive du TDAH devrait réduire de manière significative le risque d'obésité. La détection et le traitement du TDAH chez les adolescents souffrant d'obésité sont importants pour la prévention et la prise en charge de cette pathologie souvent réfractaire aux traitements habituels de l'obésité.

Evaluation of the impact of the COVID-19 lockdown on BMI in children and adolescents with or without obesity.

BACKGROUND: In Switzerland, from March 15th to May 11th 2020, schools and most shops were closed nationwide due to the COVID-19-related lockdown. This cessation of activities may have impacted weight gain in children and adolescents. The aims of our study were to evaluate the effects of the COVID-19 lockdown on the BMI of children and adolescents in treatment for obesity, and to compare its evolution to that of the previous year at the same time, as well as to that of normal-weight children. METHODS: This retrospective study gathered demographic and anthropometric data from subjects aged 6-18 years both with normal weight and with obesity, who attended our hospital clinics at four time points: before and after the lockdown period in 2020, and at the same times of the year in 2019. We used paired t-tests to assess weight, BMI and BMI z-score changes, linear and standard multiple regressions, independent Student's t-tests or Chi-square tests to compare groups, and Pearson correlation coefficient when appropriate. RESULTS: Forty-seven children with obesity and 18 normal-weight subjects had complete data for the 4 visits. The mean BMI increased in both groups during the lockdown (obese: + 0.96 ± 1.5 vs. control: + 0.51 ± 0.1), however the increase was significantly more important in the subjects with obesity compared to the same period in 2019 (2019: + 0.33 ± 1.0; mean difference between 2019 and 2020: + 0.63 ± 2.0 p = 0.034). CONCLUSION: The COVID-19 lockdown had a negative impact on the BMI of youth with obesity. Interestingly we observed extreme changes in this population, which was not the case in normal-weight children. Therefore, families with a child with obesity must be actively supported during these stressful and obesogenic periods of confinement.

[Health needs of unaccompanied minors - An experience of a consultation for adolescents in Geneva]. / Besoins de santé des mineurs non accompagnés - L'expérience d'une consultation d'adolescents à Genève.

This article addresses the health needs of unaccompanied undocumented minors (UMs) received in Geneva. In our experience and according to the literature, the most frequent diagnoses in this population are depression, anxiety disorder, posttraumatic stress disorder and substance abuse. Their medical and psychological treatments are often complicated by their psychosocial difficulties as well as by their wandering. Their treatment should be given by a multidisciplinary care team that works with the different structures that support them both socially and administratively. The adolescent health unit of the Geneva University Hospital give them the opportunity to reclaim their physical and mental health. It also enables them to bond with others and rethink their future trajectories.

Cet article propose d'aborder les besoins de santé des mineurs non accompagnés non requérants d'asile accueillis à Genève. Dans notre expérience et selon la littérature, les diagnostics les plus fréquents dans cette population sont les troubles anxio­dépressifs, l'état de stress post-traumatique et les abus de substances. Leur prise en charge, souvent compliquée par leurs difficultés psychosociales et leur errance, devrait se faire par une équipe pluridisciplinaire de soins ainsi qu'en réseau avec les différentes structures qui les soutiennent sur le plan social et administratif. L'Unité santé jeunes (USJ) des Hôpitaux universitaires de Genève leur propose des espaces pour se réapproprier leur santé tant physique que psychique, afin de leur donner la possibilité de se lier à l'autre et de repenser leur errance.

[Eating disorders and obesity in adolescents†: clinical implications]. / Troubles des conduites ­alimentaires et obésité à l'adolescence†: ­implications cliniques.

Binge eating disorder (BED) is associated with obesity and a quarter of adolescents with weight excess may suffer from the complete or a partial form of this disorder. A systematic screening for BED should be performed in this population as non-identification will complicate the patient's management. A short screening tool, -named ADO-BEDs, was specifically developed for these adolescents. This latter tool appears to be useful to guide the medical consul-tation. As such, the health professional will be able to refer the -patient for further evaluation in case of BED suspicion. Health -professionals should be aware that body dissatisfaction or teasing triggered by the adolescent's body are not an incentive to lose weight and increase the risk of eating disorders. Therefore, negative comments should be avoided in consultation.

Les troubles des conduites alimentaires (TCA) de type accès ­hyperphagiques sont associés à l'obésité et sont présents sous leurs formes complètes ou partielles chez près d'un quart des adolescents en excès de poids. Un dépistage systématique doit être effectué dans cette population lorsqu'elle consulte, afin de permettre une prise en charge optimale. Un outil de dépistage nommé ADO-BEDs a été spécifiquement développé pour ces ­adolescents. Utile pour guider la consultation, il permet au ­soignant d'aborder le trouble et d'adresser le patient pour une évaluation spécialisée en cas de suspicion de TCA. Viser une ­augmentation de l'insatisfaction corporelle ou faire des commentaires négatifs portant sur le physique de l'adolescent ne sont pas une aide à la motivation, mais augmentent le risque de TCA et devraient être évités en consultation.

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study.

BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

Bioimpedance-measured volume overload predicts longer duration of mechanical ventilation in intensive care unit patients.

PURPOSE: Bioelectrical impedance analysis (BIA) is a technology that provides a rapid, non-invasive measurement of volume in body compartments and may aid the physician in the assessment of volume status. We sought to investigate the effect of BIA-measured volume status on duration of mechanical ventilation, 28-day mortality, and acute kidney injury requiring renal replacement therapy in a population of medical/surgical patients admitted to the intensive care unit (ICU). METHODS: Prospective observational study of adult patients who required mechanical ventilation within 24 hr of admission to ICU. Bioelectrical impedance analysis measured extracellular water (ECW) and total body water (TBW) and these measurements were recorded on days 1, 3, 5, and 7. RESULTS: A total of 36 patients were enrolled. Mean (standard deviation) age was 61.8 (21.3) years and 31% of patients were female. The majority were admitted from the emergency department or operating room. The most common diagnosis was sepsis. At 28 days, eight patients (22%) had died. There was no association between ECW/TBW ratio at day 1 and 28-day mortality (odds ratio, 1.2; 95% confidence interval [CI], 0.6 to 2.3) after adjusting for age, sex, and Acute Physiology and Chronic Health Evaluation II score. The median [interquartile range] number of ventilator days was 5 [2.5-7.5]. On day 1, for each 1% increase in the ECW/TBW ratio, there was a 1.2-fold increase in ventilator days (95% CI, 1.003 to 1.4; P = 0.05). It is notable that 20% of eligible patients could not be enrolled because medical equipment interfered with correct electrode placement. CONCLUSION: Bioimpedance-measured ECW/TBW on day 1 of admission to the ICU is associated with time on the ventilator. While this technology may be a useful adjunct to the clinical assessment of volume status, there are technical barriers to its routine use in a general ICU population.

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review.

BACKGROUND: Hemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g., cool dialysate) may reduce the occurrence of HIRRT, but less is known about interventions to prevent HIRRT in critically ill patients receiving RRT for acute kidney injury (AKI). We sought to evaluate the effectiveness of RRT-related interventions for reducing HIRRT in such patients across RRT modalities. METHODS: A systematic review of publications was undertaken using MEDLINE, MEDLINE in Process, EMBASE, and Cochrane's Central Registry for Randomized Controlled Trials (RCTs). Studies that assessed any intervention's effect on HIRRT (the primary outcome) in critically ill patients with AKI were included. HIRRT was variably defined according to each study's definition. Two reviewers independently screened abstracts, identified articles for inclusion, extracted data, and evaluated study quality using validated assessment tools. RESULTS: Five RCTs and four observational studies were included (n = 9; 623 patients in total). Studies were small, and the quality was mostly low. Interventions included dialysate sodium modeling (n = 3), ultrafiltration profiling (n = 2), blood volume (n = 2) and temperature control (n = 3), duration of RRT (n = 1), and slow blood flow rate at initiation (n = 1). Some studies applied more than one strategy simultaneously (n = 5). Interventions shown to reduce HIRRT from three studies (two RCTs and one observational study) included higher dialysate sodium concentration, lower dialysate temperature, variable ultrafiltration rates, or a combination of strategies. Interventions not found to have an effect included blood volume and temperature control, extended duration of intermittent RRT, and slower blood flow rates during continuous RRT initiation. How HIRRT was defined and its frequency of occurrence varied widely across studies, including those involving the same RRT modality. Pooled analysis was not possible due to study heterogeneity. CONCLUSIONS: Small clinical studies suggest that higher dialysate sodium, lower temperature, individualized ultrafiltration rates, or a combination of these strategies may reduce the risk of HIRRT. Overall, for all RRT modalities, there is a paucity of high-quality data regarding interventions to reduce the occurrence of HIRRT in critically ill patients.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale.

OBJECTIVE: To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity. STUDY DESIGN: We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?2 or Fisher exact tests were used. RESULTS: There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%). CONCLUSIONS: The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.

Comparison of serum concentrations between different dosing strategies of posaconazole delayed-release tablet at a large academic medical centre.

It is unclear if the prophylaxis dose of 300 mg/day is sufficient for achieving serum concentrations targeting the treatment of invasive fungal infections. To evaluate differences between PCZ serum concentrations in patients receiving the DRT vs the OS and in patients receiving higher doses than 300 mg/day of the DRT, a retrospective review was conducted on inpatients who received PCZ for either treatment or prophylaxis. Baseline demographics including comorbid conditions, indication and dose of therapy were collected. Serum trough concentrations were collected at steady state. Fifty-seven patients received PCZ during the study period. A total of 35 levels were collected (DRT n = 18, OS n = 17). Patients receiving the DRT had levels >0.7 mcg/mL 100% of the time compared to 58.8% in those receiving the OS. No significant difference was seen in serum concentrations at 300 mg/day (n = 14) vs 400 mg/day (n = 8) of the DRT (1.55 mcg/mL (1.08-2.50) vs 2.5 mcg/mL (1.85-2.70), P = .19). The DRT leads to more consistent levels in the therapeutic range than the OS. Standard dosing of 300 mg/day with DRT achieves adequate concentrations for prophylaxis and treatment of IFIs, although further data are needed to determine optimal serum concentrations for treatment.

[Integration of a palliative care approach in the management patients with polymorbidity]. / Intégration d'une approche palliative dans la prise en charge des patients atteints de multimorbidités.

The number of patients with multimorbidity is steadily increasing due to medical progress and increased life expectancy. A palliative approach may be offered to some of these patients. It includes the detection and management of somatic and mental symptoms, the management of social and spiritual problems, the anticipation of care and support of the relatives. Its main goal is to improve patient's quality of life and reduce interventions that are unnecessary, or undesired by patients themselves.

Medical and non-medical complications among children and adolescents with excessive body weight.

BACKGROUND: The burden of disease from childhood obesity is considerable worldwide, as it is associated with several co-morbidities, such as dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and psychosocial problems. We aimed at determining the prevalence of these complications in a population of children and adolescents with body weight excess. METHODS: This is a cohort study including 774 new patients (1.7 - 17.9 yrs, mean 11.1 ± 3.0) attending a pediatric obesity care center. We assessed personal and family medical histories, physical examination, systemic blood pressure, biochemical screening tests. RESULTS: We found that the great majority of the children suffered from at least one medical complication. Orthopedic pathologies were the most frequent (54%), followed by metabolic (42%) and cardiovascular disturbances (31%). However, non-medical conditions related to well-being, such as bullying, psychological complaints, shortness of breath or abnormal sleeping patterns, were present in the vast majority of the children (79.4%). Family history of dyslipidemia tends to correlate with the child's lipids disturbance (p = .053), and ischemic events or T2DM were correlated with cardiovascular risk factors present in the child (p = .046; p = .038, respectively). CONCLUSIONS: The vast majority of obese children suffer from medical and non-medical co-morbidities which must be actively screened. A positive family history for cardiovascular diseases or T2DM should be warning signs to perform further complementary tests. Furthermore, well-being related-complaints should not be underestimated as they were extremely frequent.

Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study.

BACKGROUND: COPD is a progressive lung disorder with rates of mortality between 36-50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD. METHODS/DESIGN: The study is a three year single centre, randomized controlled trial using a 2 arms parallel groups design conducted in a tertiary center (University Hospitals; Geneva). For the intervention group, an early palliative care consultation is added to standard care; the control group benefits from standard care only. Patients with COPD defined according to GOLD criteria with a stage III or IV disease and/or long term treatment with domiciliary oxygen and/or home mechanical ventilation and/or one or more hospital admissions in the previous year for an acute exacerbation are eligible to participate. Allocation concealment is achieved using randomisation by sealed envelopes. Our sample size of 90 patients/group gives the study a 80% power to detect a 20% decrease in intensive care unit and emergency admissions--the primary endpoint. All data regarding participants will be analysed by a researcher blinded to treatment allocation, according to the "Intention to treat" principle. DISCUSSION: Given the trends toward aggressive and costly care near end-of-life among patients with COPD, a timely introduction of palliative care may limit unnecessary and burdensome personal and societal costs, and invasive approaches. The results of this study may provide directions for future palliative care interventions in this particular population. TRIAL REGISTRATION: This trial has been registered at clinicaltrials.gov under NCT02223780.

[Specialized adolescent health clinic: who should be referred to it?]. / Consultations spécialisées en médecine de l'adolescent: à qui s'adressent-elles?

Adolescent health clinics were created in response to the specific health needs of this age-group. Adolescents may present complex health problems which require a multidisciplinary and global assessment. The aim of this article is to provide an overview of the type of health problems for which adolescents are referred to our clinics and the care they receive in response to them.

Meta-analysis evaluating apixaban in patients with atrial fibrillation and end-stage renal disease requiring dialysis.

Background: Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can offer significant stroke prevention in this population, the accompanying major bleeding risks make warfarin nearly prohibitive. Apixaban was shown to be superior to warfarin in preventing stroke or systemic embolism, with a lower risk of bleeding and mortality in a large, randomized trial of individuals with mostly normal renal function but none with ESRD. Methods: We systematically reviewed evidence comparing apixaban versus warfarin for atrial fibrillation in this population, and evaluated outcomes of stroke or systemic embolism, and major bleeding using random-effects models. The main safety outcome was major bleeding, and the main effectiveness outcome was stroke or systemic embolism. Results: We found five observational studies of 10 036 patients (2638 receiving apixaban, and 7398 receiving warfarin) meeting inclusion criteria. Pooled analysis demonstrated a significant reduction in major bleeding with apixaban as compared to warfarin (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42-0.61; p < .0001). Apixaban was also associated with a reduction in intracranial bleeding (OR 0.58, 95% CI 0.37-0.92; p = .02) and in gastrointestinal bleeding (OR 0.61, 95% CI 0.51-0.73; p < .0001). Furthermore, apixaban was associated with a reduction in stroke/systemic embolism (OR 0.64, 95% CI 0.50-0.82; p < .0001). Conclusion: Apixaban was associated with superior outcomes and reduced adverse events compared to warfarin in observational studies of patients with atrial fibrillation on dialysis. Randomized controlled studies are needed to confirm these findings.

BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study.

BACKGROUND: Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. METHODS: This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. RESULTS: Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependent of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). CONCLUSIONS: Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.

Bioimpedance-Guided Monitoring of Volume Status in Patients With Kidney Disease: A Systematic Review and Meta-Analysis.

Background and Objective: Bioimpedance technologies are increasingly used to determine fluid status in patients with chronic kidney disease and those with end-stage kidney disease on dialysis. We aimed to determine whether this technology improves clinical outcomes as compared with usual care. Methods: We performed a systematic review and meta-analysis of trials, comparing fluid management guided by bioimpedance technologies to standard of care in patients with chronic kidney disease. Our primary outcome was all-cause mortality. Secondary outcomes included blood pressure control, all-cause hospitalization, major adverse cardiovascular events, and change in left ventricular mass index. Results: Our search identified 819 citations of which 12 randomized controlled trials were included (2420 patients). No studies of non-dialysis-dependent chronic kidney disease patients met inclusion criteria. Mean age was 55 years and mean follow-up was 1 year. There was a statistically significant difference in all-cause mortality between both arms studied (risk ratio [RR] 0.64, 95% confidence interval [CI]: 0.44, 0.99). Better blood pressure control was observed in the bioimpedance arm of the included articles, weighted mean differences (WMD) -3.13 mm Hg (95% CI: -5.73, -0.53 mm Hg) for systolic blood pressure and WMD -2.50 mm Hg (95% CI: -4.36, -0.64 mm Hg) for diastolic blood pressure. No difference was observed concerning the other outcomes. Conclusions: Among patients on maintenance dialysis, bioimpedance-guided volume management showed decreased all-cause mortality and blood pressure but no significant difference in all-cause hospitalization, major adverse cardiac event, or change in left ventricular mass index. This may be due to a younger population sample than previous articles. Moreover, our study identified a knowledge gap by highlighting the lack of studies evaluating this technology in non-dialysis-dependent chronic kidney disease patients.

Contexte et objectif: Les technologies de bio-impédance sont de plus en plus utilisées pour déterminer le statut hydrique des patients atteints d'insuffisance rénale chronique et des patients atteints d'insuffisance rénale terminale sous dialyze. Notre objectif était de vérifier si cette technologie améliore les résultats cliniques des patients par rapport aux soins habituels. Méthodologie: Nous avons procédé à une revue systématique et à une méta-analyze d'essais comparant la gestion des fluides guidée par les technologies de bio-impédance aux normes de soins chez les patients atteints d'insuffisance rénale chronique. Le principal critère de jugement était la mortalité toutes causes confondues. La régulation de la pression artérielle, l'hospitalization toutes causes confondues, les événements cardiovasculaires majeurs indésirables et la modification de l'index de masse ventriculaire gauche constituaient les critères de jugement secondaires. Résultats: Notre recherche a permis de répertorier 819 citations, desquelles 12 essais contrôlés randomisés ont été retenus (2 420 patients). Aucune étude portant sur des patients atteints d'insuffisance rénale chronique non dépendants de la dialyze ne remplissait les critères d'inclusion. L'âge moyen des sujets était de 55 ans et le suivi moyen était d'un an. Une différence statistiquement significative a été observée entre les deux bras étudiés en ce qui concerne la mortalité toutes causes confondues (RR: 0.64; IC 95% entre: 0.44, 0.99). Une meilleure régulation de la pression artérielle a été observée dans le bras de bio-impédance des manuscrits inclus, soit une moyenne pondérée des écarts de −3.13 mm Hg (IC 95% entre: −5.73, −0.53 mm Hg) pour la pression artérielle systolique et de −2.50 mm Hg (IC 95% entre: −4.36, −0.64 mm Hg) pour la pression artérielle diastolique. Aucune différence n'a été observée pour les autres résultats. Conclusion: Chez les patients sous dialyze d'entretien, la prise en charge du volume guidée par la bio-impédance a montré une diminution de la mortalité toutes causes confondues et une meilleure régulation de la pression artérielle. Aucune différence significative n'a été cependant observée dans les hospitalisations toutes causes confondues, les événements cardiaques majeurs indésirables ou la modification de l'index de masse ventriculaire gauche. Ce résultat pourrait être attribuable au fait que l'échantillon de population était cette fois-ci plus jeune que les populations étudiées dans les manuscrits précédents. De plus, notre étude a permis d'identifier un écart dans les connaissances en soulignant le manque d'études évaluant cette technologie chez les patients atteints d'insuffisance rénale chronique non dépendants de la dialyze.