The correct estimation on dry weight is very important in providing effective and safe hemodialysis to end stage renal disease patients. Optimal fluid removal with minimal adverse reactions from the treatment is one goal of hemodialysis treatment. The aim of this article is to discuss different methods of assessing dry weight and to determine their role in the complex fluid management of end-stage renal disease patient. Recent literature describes various methods of determining optimal hydration state, including clinical or paraclinical methods. Each of these methods has their benefits and limitations. Despite the large number of studies conducted on new technologies for determining dry weight, there is a lack of larger, randomized controlled trials to support these methods. Although the successful use of different methods of dry weight assessment is not supported yet by large clinical trials, some evidence is starting to link the use of some methods to improved outcomes (morbidity, mortality) in this population.