N3 — Dry Weight Assessment Checklist

When: before each treatment; the full checklist at least monthly and after any hospitalization.

Do this

1. Compare today’s pre-weight and the last 2–4 post-weights with the target. Count treatments that finished more than 1 kg above target [2].
2. Calculate interdialytic weight gain (IDWG) in kg and as a percentage of target weight [3].
3. Ask: breathless lying flat? swelling? cramps, dizziness, or needing to lie down after dialysis? hours to recover after treatment? urine per day — any change?
4. Examine: edema, neck veins, lung bases.
5. Check BP lying or sitting and standing, before and after treatment; review the home BP log if the patient keeps one.
6. Review the last month: lowest systolic BP (SBP) each session, saline given, early terminations.
7. Note anything that changes flesh weight: recent admission, poor appetite, new supplements, amputation.
8. Record on the unit’s standard form — the same way, every time [4].
9. When a dry-weight probe is ordered: use your unit protocol’s step size (the DRIP trial used 0.1 kg per 10 kg of body weight per session, halved if not tolerated) [6]. Back off for cramps, saline need, symptomatic hypotension, or nadir SBP below 90.

Call the nephrologist when

• Post-weight is more than 1 kg above target in 3 or more of the last 10 treatments [2].
• IDWG is 4% or more of body weight repeatedly [3], or there is new orthopnea, crackles, or rising edema.
• Cramps, saline, or nadir SBP below 90 in 2 or more sessions in a week.
• Urine output has dropped, or IDWG has fallen sharply with poor intake or weight loss.
• The patient was just discharged from hospital.

Don’t

• Don’t lower a target weight because of one high pre-dialysis BP [5].
• Don’t rely on lung sounds or edema alone to call someone “dry” [1].
• Don’t change the target without a nephrologist order.