Answer: First of all, we need to remember the importance of a well-functioning AV fistula – we think of this as a "lifeline" for dialysis. A strong fistula can provide you with excellent and adequate dialysis and is much less likely to stop working or get infected than a chest catheter.

However, fistulas and grafts do have their own potential complications. Among these can be "steal syndrome" in which the tremendous amount of blood flow around the AV fistula takes some of the blood away from the hand. Thus your hand can feel cold, painful, numb or "tingly" at times. This is especially true if the fistula or graft is in the upper part of the arm rather than the forearm. If the sensation in the hand gets unbearable, it can often be improved by a small surgical procedure (either a "banding" or “DRIL" procedure) – in either case with your nurses and nephrologists working with you and an experienced vascular surgeon. The hand discomfort can be improved so you can continue dialyzing in a non-painful manner.

Sometimes, hand tingling or pain can be caused by a nerve problem in the arm, and not a blood vessel problem. Sometimes, nerves in the arm or hand can be damaged by the original AV access procedure itself – although this is uncommon and can improve to a significant degree with time and physical therapy.

More common nerve problems can be due to carpal tunnel syndrome, in which the nerve gets compressed at the level of the wrist. Anyone can get carpal tunnel syndrome but it is more common in dialysis patients due to a protein called amyloid, which can deposit in the soft tissue of the arm. Carpal tunnel syndrome can sometimes be treated by wearing a wrist splint at night, doing physical therapy, getting a cortisone injection at the wrist, or as a last resort, having a minor surgery on the wrist.

All in all, there are usually ways to improve hand discomfort in a dialysis patient – no matter the cause of the problem – and to preserve your very important lifeline.

Answer provided by Alan Friedman, MD. Dr. Friedman is private practice in nephrology as part of Renal Medicine, PC, in the Bronx, N.Y., with interests in all aspects of clinical nephrology and dialysis. He did his nephrology training at Montefiore Medical Center in the Bronx.

The Dear Doctor column provides readers with an opportunity to submit kidney related health questions to health care professionals. The answers are not to be construed as a diagnosis and, therefore, alterations in current health care should not occur until the patient’s physician is consulted.

This article originally appeared in the March 2006 issue of aakpRENALIFE, Vol. 21, No. 5.

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