The Skinny on Dry Weight & Dialysis

By Tricia McCarley, RN, MSN, ACNP Tory Scoggins, RN, BBA Amanda Rivenbark, RN, BSN

How many of us have squeezed our eyes shut on the doctor’s office scale or let our own bathroom scale grow a layer of dust?

Weight is a taboo topic in America. Many of us avoid it at all costs. It can be intertwined with feelings of inadequacy or weakness. Weight can be wrapped up in emotionally charged conversations around wellness and pain. Difficult though it may be, as clinicians our best advice around weight is for people with chronic kidney disease (CKD) to understand the significance of their weight as it relates to overall health.

As care providers, we understand that for people who have been living with chronic conditions, managing weight can feel like an uphill battle. So, keeping a constant eye on it, with weigh-ins at each dialysis session, can be disheartening.

Dialysis, the life-sustaining treatment for people living with kidney failure, helps people with CKD feel their best by helping maintain the right amount of fluid in the body. In order to know how much fluid to remove during dialysis, a person is weighed before and after their treatment. A person’s weight—without extra fluid in the body—is called “estimated dry weight” (EDW).

A recent overall weight loss or gain, one that could occur due to changes in diet or exercise, would also change a person’s EDW, making it all the more important for clinicians to create a space where people feel comfortable talking about their weight and any challenges they may be experiencing.

People should avoid the temptation to remove more fluid during dialysis to drop pounds on the scale. This can lead to symptoms like lightheadedness and nausea and is not effective for long term weight management.

On the flipside, extra fluid on the body, perhaps due to excessive fluid gain from eating salty foods, could cause a person on dialysis to believe he or she has gained weight. This points to the important role of the care team to ensure that people living with kidney disease have the support and education they need to best manage their condition.

The dietitian and social worker are members of the care team who can help individuals hash out weight issues and work toward building a healthier relationship with diet, exercise, and their own bodies.

We advise people to connect with their care team providers particularly if they experience cramping, dizziness, fatigue, shortness of breath, swelling, or if their weight is consistently more than one kilogram over or under their EDW. Swelling or puffiness in feet, ankles, or legs, also known as edema, can indicate extra fluid gain.

Tips for weighing yourself at home:

  • Weigh yourself every day at the same time wearing similar clothes
    and shoes.
  • Place the scale on a hard, even surface, not on carpeting.
  • Record your weight and compare it
    to your EDW.

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Tricia McCarley, RN, MSN, ACNP is the VP of Strategic Quality Operations at Fresenius Kidney Care. In this role she develops, evaluates, and implements strategic initiatives to ensure the provision  and delivery of quality patient care. Tricia has more than 40 years experience in Nephrology clinical practice. She lives in Nashville, Tennessee and enjoys spending time with her grandchildren.

Amanda Rivenbark, RN, BSN is the Senior Director of Value Based Quality Programs at Fresenius Kidney Care. She has been a nurse in the dialysis industry for the last 14 years and currently develops, plans, and implements managed care strategies focused on improving patient outcomes. Amanda lives in coastal North Carolina and enjoys spending time with her family and friends.



Tory Scoggins, RN, BBA is the Functional Vice President of Strategic Quality Initiatives at Fresenius Kidney Care. In this role, he develops and supports innovative strategies to improve the quality of care and clinical outcomes for individuals on dialysis. Tory has worked in the healthcare setting for 25 years and is passionate about making a difference in the lives of patients and their families. As a resident of Atlanta, GA, he enjoys spending quality time with loved ones and playing softball.