What question did this study set out to answer?

The study explores patients' understanding of fluid overload and dry-weight in hemodialysis.

March 14, 2026Kidney Medicine0 citationsOpen Access

The Dry-Weight Dilemma: Survey Results Based on a Qualitative Interview Study on Fluid Overload in Hemodialysis

VRVincent Rathkolb JKJulian Krauß SMSebastian Mußnig

Key Points

The study explores patients' understanding of fluid overload and dry-weight in hemodialysis.
Conducted semi-structured interviews with 25 hemodialysis patients.
Developed a survey based on interview data and distributed it to 148 patients across three centers.
Applied a mixed-methods approach with qualitative coding guided by grounded theory.
11 out of 25 interviewed patients had chronic fluid overload greater than 15%.
54.7% of surveyed patients misunderstood chronic fluid overload as occurring between dialysis sessions.
77.9% could define dry-weight, but many had uncertainties regarding its management.

Abstract

Rationale & Objective: Chronic fluid overload (FO) can be detected by bioimpedance spectroscopy (BIS) and is associated with higher mortality risk than interdialytic weight gain (IDWG) in patients receiving hemodialysis (HD).This study aimed to explore patients' perspectives and comprehension of FO and dry-weight. Study Design:Qualitative study arm of an exploratory, non-randomized observational study.Setting & Participants: Semi-structured interviews were conducted in 25 HD patients at the Vienna General Hospital.A survey was developed based on the interview data and distributed across three HD centers (n=148).Analytical Approach: A mixed-methods approach was applied: Grounded theory guided qualitative coding, while survey data were analysed descriptively.Results: 11/25 interviewed patients had chronic FO >15% BIS-defined extracellular volume pre-dialysis.Theme 1 'Being aware of fluid restrictions' contained subthemes (1a) 'Restrictive fluid intake is the major burden', (1b) 'Symptom awareness of FO', (1c) 'Misconception of chronic FO', (1d) 'Unawareness of BIS' and (1e) 'neglected salt restriction'.Subthemes 1c and 1d were reinforced by the survey, wherein 54.7% fully or partially agreed that chronic FO occurs between HD sessions (misunderstood as IDWG).Theme 2 'Dry-weight is a feel-good factor' contained subthemes (2a) 'Inconclusive definitions of dry-weight', (2b) 'Better too high than too low', (2c) 'Self-management of dryweight prescription' and (2d) 'Uncertainties in weight documentation'.In our survey, 77.9% reported being able to define dry-weight, 64.2% fully or partially agreed they currently had the correct dry-weight, and 65.0% did not feel overhydrated (chronic FO was prevalent in around 40%). 64.5% were not interested in participating in an educational event on dryweight and chronic FO.Limitations: Sample size, gender bias, the survey was not validated externally.

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