Gums bleeding and eyes closed, the young woman in the picture looks as if she is near death.
Four hours later, after her blood has been purified, a second picture shows natural, healthy color has returned to her face. Her lips -- with traces of dried blood around the corners -- are almost turned up in a smile.
It was 1961, and she was one of the first patients to undergo an experimental type of kidney dialysis in which the patient's own abdominal cavity is used to wash the blood. Yesterday morning, more than 2,500 physicians, nurses and researchers saw her photos at a world conference in Baltimore to exchange ideas about how to better treat the growing number of patients who use this kind of dialysis.
In what's called peritoneal dialysis, a solution is drained through a tube permanently implanted into the patient's abdominal cavity. As the patient moves, the solution swishes across a membrane, where it washes the blood. The solution later is drained and replaced with clean solution. The method has been used for 20 years.
About 35,000 Americans, including about 340 people in Baltimore, use peritoneal dialysis. Over the past three years, Dr. Karl D. Nolph -- conference chairman, and professor and director of nephrology at the University of Missouri-Columbia School of Medicine -- said 3 percent more dialysis patients are deciding to use the peritoneal procedure, rather than going to dialysis centers.
Dialysis takes over the essential job of cleaning impurities from the blood when diabetes, high blood pressure and other chronic diseases damage the kidneys, causing them to fail. Roughly 160,000 Americans, many elderly, undergo dialysis, while about 10,000 people, usually younger, receive kidney transplants.
Though about 80 percent of Americans with failed kidneys go to health centers three times a week for as long as four hours to have their blood cleaned -- called hemodialysis -- physicians say peritoneal dialysis can be cheaper and gives patients more independence.
Some patients use a machine to give them the solution during the night, while others change the solutions themselves three to four times a day. They must all deal with potential infections and other complications.
But they no longer have to go to dialysis centers, where blood is cycled so quickly through a machine that patients often suffer side effects like wooziness and headaches -- because their blood levels are changing so rapidly, said Dr. Nolph.
The nurses who care for these patients collected scientific literature yesterday so they could persuade physicians to use the new treatment methods. For some, the conference also was a time for catharsis.
"It's part of your life. I see these patients more than I see my own family," said Carol Hughes, a registered nurse from Atlantic City Medical Center.
Her patients give her birthday and Christmas presents, and if they die, she attends the viewing and the funeral. "It's the only way I can find closure."
Dr. Peter Hulman, who came to the conference from the Alaska Kidney Center in Anchorage, said that about half of his new patients with kidney failure decide to use peritoneal dialysis, because many are independent and want to live in remote areas. For developing countries unable to afford expensive dialysis machines, peritoneal dialysis has not only saved lives, but eliminated the nausea, vomiting, weakness and chronic fatigue that often accompany kidney failure, physicians said.
Over the years, doctors have used a dog's lungs and even a Maytag washing machine to clean people's blood, said Dr. Eli Friedman, chief of renal diseases at the State University of New York at Brooklyn, who gave the keynote address. In the next several years, he said, physicians may use bionic organs, kidneys from pigs and goats, and the patient's own bowels.
