Background/Aims: Left ventricular hypertrophy (LVH) has long been known as an independent risk factor for cardiovascular deaths, in both dialysis and general populations. Numerous factors influence the pathophysiology of LVH. However, extracellular fluid may have a particularly important influence on this impact. Inferior vena cava diameter (IVCD) estimation is a non-invasive and relatively convenient method for obtaining a good correlation with the intravascular fluid status, and may obtain an optimal dry weight (DW) for chronic hemodialysis patients. This study estimates the DW of end-stage renal disease (ESRD) patients by echocardiographic measurement of the IVCD to observe changes in cardiac morphology and function. Methods: A total of 88 patients, ranging from 26 to 90 (59.4 ± 13.3) years of age, were involved in this study. The patients were divided into study (n = 48) and control (n = 40) groups. All patients received IVCD assessment via echocardiography bi- monthly for 1 year. In the study group patients, DW was adjusted according to the IVCD by echocardiography. Meanwhile, in the control group patients, DW was adjusted based on traditional clinical parameters. All patients underwent cardiac examinations and measurements, including left ventricular mass (LVM), wall thickness, chamber size and left ventricular systolic function by echocardiography, at the beginning and end of the study. Results: Both groups displayed comparable clinical and biochemical parameters. The IVCD index correlated well with the cardiac parameters estimated by echocardiography. The LVM and left ventricular mass index (LVMI) was reduced significantly in the study group patients (from 200 ± 64.2 to 187 ± 63.2 g, p = 0.021; from 132 ± 37.6 to 123 ± 37.3 g/m<sup>2</sup>, p = 0.014, respectively). Furthermore, the study group patients with fluid overload, named study subgroup A, displayed significant differences not only in LVM and LVMI, but also in septal wall thickness, left ventricular end-diastolic dimension and left atrial dimension. In contrast, the control group displayed no changes in these cardiac architectures during the study period. Conclusion: Adjusting DW via the IVCD measured by echocardiography for hemodialysis patients may prevent the progression of chamber dilatation and LVH, especially for patients with fluid overload.