Clinical assessment of dry weight

Unsatisfactory control of blood pressure (BP) leading to an increased rate of cardiovascular events is the main cause of mortality in haemodialysis. BP control has deteriorated since haemodialysis session times have been reduced. Inadequate BP control most often is due to a failure to achieve and maintain dry weight. Dry weight and normotension have been gradually omitted in the goals of dialysis, satisfactory dialysis being reduced to an 'adequate' urea Kt/V. Ideal dry body weight needs a reappraisal. What is dry weight? How should it be clinically assessed, established and maintained in patients? The problems encountered in estimating dry weight can be solved at the bedside in most cases. The additional laboratory, echography and impedancemetry methods are research tools that hopefully can be made simpler and lower in cost so they can be used everyday at the bedside. In the mean time, with the exception of ambulatory blood pressure measurement, one must rely on careful and repeated clinical observation to determine and maintain dry weight.