GRANVILLE, W.Va. (AP) -- John Matheny is in the kitchen, a box of plastic wrap in one hand, a tube of numbing cream in the other. He smears the white paste over his slightly bruised left forearm, then wraps it to keep his shirt clean.
He makes some toast, pours coffee and swallows the first of 20 pills he will take today. Then he waits for the cream to numb the area where needles will be inserted under the skin to help cleanse his blood.
He does a lot of waiting these days. It is one of the hardships of living with kidney disease.
An hour later, peanut butter crackers tucked into a shirt pocket and a blanket under one arm, he swings open the door to the Morgantown Dialysis Center. It's only 5 a.m., but ''the regulars,'' as he calls them, shout cheerful greetings.
''We're just like one big family,'' Matheny says. ''We spend a lot of time together.''
This isn't how he planned to retire. At 73, he thought, he would be taking it easy.
The failure of his kidneys changed that. Now, he rises early three days a week and waits nearly four hours as machines remove, clean and return his blood -- one pint at a time.
He battles exhaustion. He eats a little. He sleeps a lot.
He doesn't make plans: He never knows how he's going to feel.
''Some days, he's lucky to get to that bed,'' says Colleen, his wife of 51 years. ''And some days, we go to Kmart.''
Matheny had been sick for more than a year. His skin itched constantly. Twice, he coughed up blood. He lost his appetite, then 30 pounds. Dark blotches appeared on his scalp.
Tests were inconclusive until July 1998, when he got a transfusion and the shocking news: His kidneys had shut down, and without dialysis, he would die.
''I assumed my days were numbered,'' Matheny says. ''I sold my car, gave my guns to my son, made a will.''
After the first few treatments, he went home and wept.
''People think of dialysis as a death sentence,'' says social worker Greg Sanders.
Often, they know someone who died while going through treatment. They don't consider what other health problems might have contributed. They don't realize they can live for decades.
The first months are the hardest.
''Either they're going to accept it or they're not. Even if they do, they're not always going to feel good,'' Sanders says. ''It's life-sustaining, but it's a complicated process, and you will have bad days.''
Matheny's free hand suddenly clamps down on the arm of the gray vinyl recliner. He grimaces. A technician who's still in training is trying to insert a 15-gauge needle into his fistula, the passage on his forearm where vein and artery have been surgically attached to form a larger opening. Although the fistula leaves a clearly visible lump on his arm, the technician must still find the opening that will accept the needle.
He sneers at the young woman and rolls his eyes.
Did the numbing cream work?
''Not too good this time,'' he mutters.
Two needles go in: One removes the blood, the other returns it. In between, it circulates through an artificial kidney, a cylinder filled with what looks like an unraveled white rope.
The fibers are semi-permeable, ultra-thin membranes with microscopic holes that are large enough to let molecules of water and chemicals pass, but not blood cells. On one side of the membrane is a clear liquid called dialysate, a solution of sodium, calcium, potassium and glucose. On the other, blood.
As they pass each other, toxins and extra fluid in the blood move into the dialysate.
Healthy kidneys filter the entire blood supply -- about five quarts for the average adult -- every two minutes; Matheny waits three hours and 45 minutes.
Halfway through, hunger forces him to rip open the crackers. The room is cold to minimize the risk of infection, so he pulls the blanket over his shoulders.
In the chairs around him, hooked to machines of their own, ''the regulars'' read books or nap.
Matheny doesn't sleep; it's too noisy.
For a while, he watches the news on an overhead TV.
Every year, nearly 60,000 Americans die of kidney disease, most commonly caused by diabetes and high blood pressure. About 260,000 rely on dialysis for survival.
Demand for treatment is so great the Morgantown center runs shifts from 5 a.m. to 9 p.m. most days.
Some dialysis patients are waiting for a transplant, but most, like Matheny, have too many complicating health problems.
With dialysis, he still risks anemia, hepatitis, bone disease or an inflammation of the heart sac. He is susceptible to nerve damage and heavy bleeding from anti-clotting drugs.
His daily pills include calcium, iron and vitamin supplements, blood pressure medicine and antihistamines to stop the itching.
He's supposed to be on a high-protein, low-salt diet, with plenty of eggs and meats but no milk, cheese, peas, oranges or -- his favorite -- beets.
''But I do it,'' Matheny says. ''If I want.''
Chronic kidney disease, the ninth-leading cause of death in the United States, is one of the nation's most expensive illnesses. The annual cost of treatment is estimated to exceed $14.5 billion.
Matheny, a coal miner for 44 years, has a pension and health insurance.
Others aren't so lucky. Medicaid and Medicare usually cover 80 percent of the costs. Some get Supplemental Security Income for the balance.
If that doesn't work, they pay what they can, when they can. For some, it's as little as $5 a month.
In the 1940s, before dialysis was widely available, Matheny lost a 24-year-old brother to kidney disease.
When he started his own treatment decades later, his arm was black with bruises from wrist to bicep. When his veins collapsed, he had angioplasty to reopen them.
Earlier this month, one of ''the regulars'' quit coming in for his dialysis treatments. Matheny had tried to talk him out of it, but the 56-year-old man had had enough. And he wasn't about to change his mind.
Within two weeks, he was dead.
Matheny hasn't forgotten his own misery at times, but he finds hope now in the face of another of the ''regulars,'' a woman who's lived on dialysis for 28 years.
''I'm not going to quit,'' he says, and there is defiance in his voice.
On the Net:
American Association of Kidney Patients: http://www.aakp.org/
National Kidney Foundation: http://www.kidney.org/
American Kidney Fund Inc.: http://www.kidneyfund.org/
End Adv for Thursday, Jan. 24, and thereafter
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