An accurate assessment of dry-weight (DW) is critical in children on chronic hemodialysis (HD) to avoid the risk of both volume overload and volume depletion. It requires a comprehensive evaluation, which includes clinical history, physical examination and diagnostic tools, such as bioimpedance analysis and non invasive volume monitoring. An optimal sodium balance, an adequate interdialytic weight gain and intensified HD schedules are the key points to reach DW. This review focuses on the risk of volume overload and depletion, on the methods of DW assessment and on the best strategies to reach DW in children on HD.
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