DURHAM — Renal dialysis is the process of cleaning the toxins out of someone's blood when their kidneys quit working. Complicated machines remove a persons blood a little at a time and filter out the salt, waste and extra water.

At the Duke Dialysis Center, the machines and patients require constant monitoring by specially trained nurses who take their commitment very seriously.

"This is what we call the kidney, the machine kidney, since my kidneys obviously don't do the job," says Joe Lomick, pointing to the dialysis machine.

The dialysis machines have to do in four hours, three times a week, what your kidneys do 24 hour a day.

"It is pretty much a routine run, and I hate to use the term routine, because we do have a patient on the machine with about 200 cc's of blood flowing outside their body, but they consider that a pretty routine thing to do since dialysis is chronic," says nurse Loretta Ezell.

It is the continuous care aspect of dialysis that attracts these nurses to this specialty.

"I wanted to do something different," Ezell says. "Dialysis just seemed to be something that was different, it was challenging. I got to work with the same group of patients repeatedly and that was going to be new for me and that is why I wanted to try dialysis. I came here in '91, and I have been here since."

When kidneys do not work, toxins must be cleaned out by dialysis three times a week. This requirement makes it tough for patients to have jobs and care for families, along with the fatigue that comes with dialysis. They often look to the medical staff for emotional relief.

"I think the hardest part of the job is to watch our patients come, to sort of get attached, because you just can't help but get attached when you see your patients as often as we do," says Ezell. "And then to watch that patient maybe get an illness or have something happen to them and then they take a steady downhill decline, and there is nothing we can do about it sometimes."

The nurses thrive on the long term relationships with patients.

"We have two that have been here 36 years, that is since Duke started doing dialysis," Ezell notes.

Lomick does not give a second thought to coming to his four hour long renal dialysis treatments three times a week.

"You know, dialysis is important. Without it I would not be here, I would not be alive. Since I have been on dialysis, I have missed one treatment, and that has been over ten years," he says.

People most often need dialysis as a result of complications from diabetes, hypertension and drug abuse.

But having your blood removed and cleansed is just part of dialysis.

The problem is getting the patients to actually follow the diet that it takes to maintain their health, which can be very difficult, because the average patient is allowed about a quart and a half of fluid a day.

That quart and a half includes soups, gravy, natural juices in fruit, and all beverages. A quart and a half of fluid is equal to two cups of coffee and a bottle of water and a Coke. Add this restriction to the complex diet of a diabetic, and compliance can be a challenge.

"I mean there is a lot of stuff you can't eat, like food that is high in potassium, like bananas, and my favorite is watermelon, and you can't have that because it is a double [dose] of water and potassium," says Lomick.

"This is not something where you can say, I will come today but I am not going to come for the rest of the week. You are definitely going to end up in the hospital with some serious problems," says Ezell.

But many of these patients know this is part of their life to keep them alive.

"It is not discipline when you got to do it. Discipline is when you have got other alternatives, but when you got to do something, you want to live and have a healthy life. That is great incentive," laughs Lomick.

Renal dialysis is a life-long commitment for patients, unless they have a kidney transplant. Nurses at the Duke Dialysis Clinic tell us often patients who get transplants love to come back and visit because dialysis was such a big part of their lives.

The Duke Dialysis Center on Moreen Road has 58 patients, and the hospital clinic has 600 patients. Some have been coming there for over 20 years. Nurses also train some patients to do their dialysis treatment at home.