# N3 — Dry Weight Assessment Checklist

N3 — Dry Weight Assessment Checklist FRONT Front · at the chair

**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 \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-2)\].
2.  Calculate interdialytic weight gain (IDWG) in kg and as a percentage of target weight \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-3)\].
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 \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-4)\].
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) \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-6)\]. 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 \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-2)\].
- IDWG is 4% or more of body weight repeatedly \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-3)\], 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 \[[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-5)\].
- Don’t rely on lung sounds or edema alone to call someone “dry” \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-1)\].
- Don’t change the target without a nephrologist order.

N3 — Dry Weight Assessment Checklist BACK Back · why, and the evidence

### Why

1.  Crackles and edema miss most of the lung congestion found by ultrasound (agreement κ 0.00–0.16) \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-1)\].
2.  Finishing more than 1 kg above target in 30% or more of treatments raised the 30-day risk of emergency visits and hospitalization \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-2)\].
3.  Relative IDWG of 4% or more was linked to fluid-overload hospitalization; 5.7% or more was linked to higher mortality \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-3)\].
4.  Units with a written schedule for reassessing dry weight had lower mortality (HR 0.78) \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-4)\].
5.  BP falls weeks after dry weight is corrected, so today’s BP cannot judge the target \[[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-5),[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html#n3-ref-6)\].

### Go deeper

- Mastery page: [Estimating dry weight: assessment, tools, probing](https://urinenephrology.org/mastery/maintenance-hd/dry-weight-assessment.html)
- [All dialysis nursing reference cards](https://urinenephrology.org/mastery/maintenance-hd/nursing/index.html)

### References

1.  Torino C, et al. The agreement between auscultation and lung ultrasound in hemodialysis patients: the LUST study. *Clin J Am Soc Nephrol.* 2016;11:2005-2011. [PubMed 27660305](https://pubmed.ncbi.nlm.nih.gov/27660305/)
2.  Assimon MM, et al. Failed target weight achievement associates with short-term hospital encounters among individuals receiving maintenance hemodialysis. *J Am Soc Nephrol.* 2018;29:2178-2188. [PubMed 29793962](https://pubmed.ncbi.nlm.nih.gov/29793962/)
3.  Wong MM, et al. Interdialytic weight gain: trends, predictors, and associated outcomes in DOPPS. *Am J Kidney Dis.* 2017;69:367-379. [PubMed 27866963](https://pubmed.ncbi.nlm.nih.gov/27866963/)
4.  Dasgupta I, et al. Associations between hemodialysis facility practices to manage fluid volume and intradialytic hypotension and patient outcomes. *Clin J Am Soc Nephrol.* 2019;14:385-393. [PubMed 30723164](https://pubmed.ncbi.nlm.nih.gov/30723164/)
5.  Charra B, et al. Blood pressure control in dialysis patients: importance of the lag phenomenon. *Am J Kidney Dis.* 1998;32:720-724. [PubMed 9820439](https://pubmed.ncbi.nlm.nih.gov/9820439/)
6.  Agarwal R, et al. Dry-weight reduction in hypertensive hemodialysis patients (DRIP): a randomized, controlled trial. *Hypertension.* 2009;53:500-507. [PubMed 19153263](https://pubmed.ncbi.nlm.nih.gov/19153263/)

Reviewed by Andrew Bland, MD, FACP, FAAP · v1.0 draft 2026-09-26. For education; the physician’s written order and the unit protocol always govern.


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[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N3-Dry-Weight-Assessment-Checklist.html) · Markdown synchronized October 3, 2026.