* Cardiovascular disease
* Infections due to weakened immune system
* Bone disease
* Muscle cramps
Source: Dr. Frank Miller, Nephrology Associates
Albert Lee Simmons walks with a cane, his knees half bent, his back stooped over.
"Can I borrow your legs?" he jokes to a fellow patient in the waiting room at the Dialysis Clinic in East Ridge.
Simmons comes to dialysis three times a week, every Tuesday, Thursday and Saturday. It has been his routine for 30 years.
He was diagnosed with high blood pressure in his early 30s, and his kidneys began to fail. A transplant was possible, but there were risks involved and he didn't want to take them.
"I got depressed," he said. "I told my wife, 'I'm going to go home and die.' "
"We have five children," she reminded him. "Who's going to help me raise them?"
That was in 1982. Earlier this month, Simmons was fitted with a red cape and gold crown as his fellow patients and the staff made him king for a day, celebrating his 30th anniversary at the clinic. He is well known around here, not only for being the patient with the most seniority, but also for being a scamp.
"You need to give me some sugar," he teases a nurse.
"Behave thyself," she replies, with mock sternness.
"I'm behaving," he says.
Simmons loves to flirt with all "the girls," as he calls them, but he promises: "I don't mean no disrespect. I'm just having fun."
Dr. Frank Miller, Simmons' nephrologist, said humor carries Simmons a long way. Attitude, he said, can be everything.
"Just because you go to dialysis doesn't mean you can't lead a long, productive life," Miller said.
"Being on the kidney machine," said Simmons, "is not the end of your life."
When he was first diagnosed with high blood pressure, his doctors tried to solve the problem with medicine. But it wasn't enough. Fluid on his lungs caused wheezing, shortness of breath and eventual hospitalization.
"When I woke up in the ICU," he said, "they done cut my arm, and they told me 'you're going to have to go on dialysis.' "
The cut in his arm was the beginning of an arteriovenous fistula, a surgical connection of an artery directly to a vein, which, with exercise, grows to be enlarged so the dialysis needles -- two, not one -- can be more easily inserted.
"I never got used to them sticking needles in me," Simmons said, "but I tolerate it because I need to do it."
As the kidney function decreases, so does urine production. Eventually, dialysis becomes the only way to get fluid off the body.
Simmons has to restrict his fluid intake -- 64 ounces a day -- and watch his sodium, potassium and phosphorus intake. That means very little of his beloved Coke. Sometimes, when he gets extra thirsty in the summer, he drinks more than he is supposed to, then sits in a closed car so he can sweat the fluid off.
"I have my own oven," he said.
Lois, his wife of 42 years, can tell when he's had too much fluid, he said. His face gets puffy and his stomach swells.
He met her in 1969. He was 19, she was 16. She was wearing a white blouse and green shorts. He talked to her on a front porch, and that was it. He was hooked.
Lois is more serious than he is, he said. "She don't go for all this joking and going on. She's a good lady."
He worked pouring iron, then in carpentry. Now, he said, dialysis is his job.
"I want to get some benefits," he laughs from behind his silver-rimmed sunglasses.
When it's time for Simmons' treatment, he goes to get weighed first. On this day, he has gained 3.6 kilos, about 8 pounds, of fluid since his last session.
"It's kind of rough on the weekends," he says.
The dialysis room is brightly lit, with white walls and linoleum floors. Patients sit in large green chairs, machines whirring. A steady, high-pitched beeping sounds a rhythm.
Patient care technician Chris Elrod gets Simmons settled into his chair, propping his arm on a pillow and taking his temperature. Simmons doesn't stop talking, chattering to other patients, joking with "Mr. Chris," grinning with his broad smile.
He's made friends here, he said.
"I've met some good people in the time I've been here. They let me act like a fool."
He looks out for the others, alerting staff when he sees someone in discomfort or distress.
"A lot of the folks," he said, "don't holler loud enough."
Elrod draws blood to test Simmons' calcium and phosphorus levels. Simmons grimaces when the needles go in. Nurse Kaye Smith assesses his breath sounds and checks to see if his ankles are swollen from fluid.
As blood begins to leave his body, it shows light at first, mixed with the saline from the intravenous drip. The blood flows out into the dialyzer, which acts an artificial kidney, filtering out excess salt, water and chemicals, before returning to the body.
Simmons will sit for about three hours while the machine cleans his blood, so he's going to take a nap, he says.
"You can look at (dialysis) as being tethered to a machine for several hours," said Miller, "or you can look at it as the machine is your new best friend. It's keeping you alive."
"A lot of dialysis goes on in your head," the doctor said. "Albert's attitude has served him well."