Relationship between “Dry Weight” and Actual Weight Loss in Patients Hospitalized for Heart Failure

Introduction In the treatment of patients with acute decompensated heart failure (ADHF) estimation of the degree of volume overload is critical in guiding the goals of diuretic therapy. A “dry weight,” or the weight of a patient when they are euvolemic, is commonly used by clinicians to determine when to discontinue diuretic therapy during hospitalization. However, it is unclear how this dry weight relates to the actual weight loss achieved during hospitalization. Hypothesis Dry weight will have limited correlation with the ultimate weight loss achieved during hospitalization. Methods Patients hospitalized for ADHF with volume overload and receiving IV diuretics were enrolled. Each participant completed a clinical assessment survey that asked, “How many pounds of water weight are you above your dry weight?” We additionally extracted any dry weight that was documented in the electronic medical record (EMR) and the lowest documented weight in the EMR within the previous year. The primary comparison was to evaluate the correlation between the patients’ estimate above their dry weight and the degree of weight loss during ADHF hospitalization. Results 343 patients were enrolled and 246 (73%) were able to describe the amount of fluid above their dry weight, which was on average 15±18 lbs above ideal weight. The patient's estimate of their fluid excess correlated modestly with their actual weight loss during the admission (r= -0.38, P Conclusion Both the estimated and the EMR documented dry weight were only modestly correlated with the actual weight loss achieved during diuresis. Additional research is required to understand if the discrepancy between diuretic induced weight loss and “dry weight” is driven by inaccuracy in the “dry weight” or variability in the diuresis of these patients.