Chronic kidney disease (CKD) is a serious health problem worldwide and its burden on health care is increasing progressively. As the kidney function deteriorates and end-stage renal disease (ESRD) approaches, the patients require renal replacement therapy (RRT). Haemodialysis is the most preferred option for RRT. This requires repeated access to circulation for frequent maintenance haemodialysis (MHD). Arteriovenous fistula (AVF) is the preferred vascular access for MHD owing to its durability and low complication rate. Such access can result in complications. One such complication of AVF is distal hypoperfusion leading to rest pain & digital ischemia even resulting in gangrene.
We present a case of 62 years old male who was a known case of Type2 Diabetes Mellitus (T2DM) and CKD for 5-years. He was on MHD for the past three years. His glycaemic status was well controlled with lifestyle modification & DPP4 Inhibitor (teneligliptin). He presented with slowly progressive rest pain, blackish discolouration of left thumb and index finger for past one year. Clinical exam and Doppler studies of left hand were suggestive of digital hypoperfusion distal to AVF. He was managed conservatively with NSAIDs, calcium channel blockers, hand warming and exercises. The purpose of this case report is to highlight this uncommon complication of the most used vascular access for MHD.
