Background: Adequate assessment of fluid status is an imperative objective in the management of HD patients. An accurate assessment of dry weight is challenging.

Objective: The aim was to assess applicability of clinical using integrated lung and IVCCI ultrasonography to assess dry weight and the adequacy of fluid removal in hemodialysis children

Patient and method: 60 patients classified into Group I who their dry weight adjusted by using integrated lung U/S and IVCCI. Group I (a) same group when dry weight adjusted by using clinical judgment.

Result: Results revealed improvement in clinical scores (orthostatic giddiness and breathlessness scores), blood pressure measurements and BNP serum levels when dry weight adjusted by integrated lung–IVC USG than when was adjusted by clinical judgment.

Conclusion: Adequacy of volume removal after a HD session can be assessed counting the number of residual B-lines on LUS and measuring IVCCI and integrated lung–IVCCI USG could be a valuable method for monitoring dry weight in pediatric dialysis patients

Keywords: Dry weight, Hemodialysis, lung and IVCCI ultrasonography.