This 68-year-old patient with Stage 4 chronic kidney disease was reviewed in our low clearance clinic 2 months after formation of a left arteriovenous fistula. The prominent ‘half-and-half’ appearance of his nails was noted. Nail disorders are common in chronic renal failure, affecting up to 70% of haemodialysis patients [1]. Half-and-half or Lindsay nails [2], where the proximal half of the na...