Blue toe syndrome after the discontinuation of statin therapy in a patient on chronic hemodialysis

A 72-year old woman on chronic hemodialysis developed cholesterol embolization syndrome after the discontinuation of statin therapy. Four months after starting hemodialysis, statin therapy had been discontinued because she developed aspecific abdominal complaints and wanted to reduce the daily amount of pills. Five months later she developed blue toe syndrome. After restarting lipid-lowering therapy (simvastatin/ezetimibe), the pain and skin lesions diminished and eventually disappeared. Many patients starting hemodialysis use a statin. However, the benefit of statins in patients on chronic hemodialysis is not completely clear. Discontinuation of statin treatment may confer so far unrecognized risks in hemodialysis patients with severe atherosclerosis. In this case, the blue toe syndrome disappeared after restarting cholesterol-lowering treatment.