First of all, it’s important to realize that there is no such thing as one ideal dry weight. An initial “ballpark” dry weight estimated by a nephrologist when you first start, after which you keep adjusting as necessary based mostly on blood pressure. You want to avoid low blood pressure but at the same time not have any significant swelling (ankles primarily).
Based on my own experience so far, once at home, you have to be very observant and aware of the signs of too low or too high a dry weight, because it will drift up and down over time as you gain or lose real weight. How do you know? Blood pressure will gradually get higher or lower until at some point you realize it’s now too low or too high. For example, if your systolic starts getting low enough that you have to give yourself saline before or during a treatment, then you know you have to do something. You don’t want it too low at home, for the simple reason that you can’t allow yourself to “crash” while on the machine. You can also check for swelling. You should be able to easily gain 2 kg or more between treatments without any swelling.
Let’s say you don’t change your dry weight…
As you gain real weight, your BP will gradually get lower and lower - and so you have to increase dry weight.
As you lose real weight, your BP will gradually get higher and higher.
… as you can tell from your pre-treatment and post-treatment BP.
It’s actually more of a problem at home, because with daily hemo, and especially daily nocturnal, you will be eating more. Appetite is better, and you have no restrictions. - plus at least with daily nocturnal, BP will definitely drop significantly, probably to better than normal without any medication. But on the other hand, on daily hemo, you might exercise more than when you were in-centre, just because you can.
Almost 3 years in-centre, I revolved around 56.5 kg DW. Sometimes went to 56, sometimes went to 57. Since I’ve been at home, I’ve gained quite a bit of weight, and my DW is now 63 kg after only 10 months at home. I got there very gradually, increasing DW 200-300ml each treatment when necessary (consulting with my nurse whenever necessary). One thing to keep in mind is that you don’t want drastic changes too fast. There is a time lag between changes in DW and changes in BP.
The big danger at home is a BP that gets too low during treatment. So, you don’t want to risk that, even if you have a helper. So, never lower your dry weight more than 200ml at a time unless otherwise instructed, and do it in consultation with your nurse.