There are different modalities of Haemodialysis

1. Intermittent Haemodialysis (IHD) TYPICALLY RUNS FOR 3-4 hrs per session and is performed three times weekly. Outpatient in centre heamodailysis for ESRD generally subjected to this modality.
2. Continuous Renal Replacement Therapy (CRRT)can be used in heamodynamically unstable patients who can’t tolerate the rapid fluid shifts of IHD. Most frequently employed form of CRRT is continuous veno venous heamodifiltration (CVVHDF).
3. Sustained low efficiency dialysis(SLED) is essentially a hybrid from of IHD and CRRT.
4. Molecular Adsorbent Recirculating System (MARS) is a liver support device used In hepatorenal syndrome.

MARS is a uniquely designed system in which there are two dialysate. In one dialysate patient blood is in counter current with human albumin. Albumin act as dialysate fluid in this dialysate and in other dialysate this albumin is in counter current with the normal dialysate fluid, which we use for normal heamodialysis. Now albumin in first dialysate taken impurities fo patient blood and goes towards the second dialysate, in the midway it regenerate itself passing through ion exchange and activated charcoal chamber. Albumin carries all the impurities including protein bound like bilirubin and gives it to ion exchange and activated charcoal chamber and then continues its journey towards the second dialysate. In the second dialysate all the water soluble impurities like creatnine and urea which are albumin and are exchange with normal haemodialysis fluid. Thus MARS dialysis takes care of both the toxins, generated due to mal functions of liver and kidney simultaneously.

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Dr Ashok Kumar, MD (MED)

Assistant Professor, Medicine, Department of Nephrology, P.M.C.H. Patna, Bihar, India