Chronic volume excess among long-term hemodialysis patients is common and if left untreated, leads to the development of heart failure and cardiac arrhythmias.1 Although potentially due to missed or shortened dialysis,2 volume excess often occurs because of its protean manifestations and diagnostic challenges. Physicians often treat the resultant hypertension with antihypertensive medication, which can further limit the opportunity for ultrafiltration on dialysis. Often these patients present with acute volume overload, requiring emergent dialysis and therefore increasing costs.