was first reported by Politico.
The two main manufacturers of equipment and supplies for dialysis said orders were up fivefold, and that they were ramping up manufacturing as well as sending equipment and nursing staff to the New York region. Baxter, which is based in Illinois, said it also saw an increase in demand from China and Europe, and was flying in extra products from Europe this weekend.
“The demand spike was so fast and so high,” said Lauren Russ, a spokeswoman for Baxter. “We’re doing everything we possibly can.”
On Friday, Fresenius announced it was creating a national supply of machines that can be moved from place to place. “We are committed to supporting hospitals with continuous supply, particularly in markets most heavily impacted, so that patients can get the care they need,” said Bill Valle, the chief executive of Fresenius Medical Care North America in Massachusetts, in a statement.
Gov. Andrew M. Cuomo of New York was asked at his briefing on Thursday about hospital reports indicating that dialysis machines were in short supply. Dr. Howard Zucker, the state’s health commissioner, said “there are not shortages across the board,” and Mr. Cuomo said that hospitals in need of equipment would get it.
In a statement, José E. Almeida, Baxter’s chief executive, said that the company was trying to prioritize the delivery of products “where they are most needed — hospitals that are being overwhelmed by an influx of patients who are critically ill from Covid-19.”
At Columbia University Irving Medical Center, Dr. Donald Landry, the chair of medicine, directly contacted Mr. Valle of Fresenius when other efforts failed and the situation grew desperate. While Dr. Landry said he was appreciative that the company responded by sending more machines, supplies and dialysis nurses, he described the experience as a warning to better prepare. “New York City gave us a glimpse of when a system comes up right to the edge,” he said.
Dr. Joshua Rosenberg, an attending physician in the intensive care unit at The Brooklyn Hospital Center, said on Thursday that he was seeing acute kidney injury in a wide range of patients, beyond those who were predisposed to kidney disease because they had high blood pressure or diabetes.
Miriam Figueroa, a dialysis nurse at the hospital, went from patient to patient on Thursday, providing three-hour dialysis treatments in a Covid-19 intensive care unit set up in a former chemotherapy infusion unit.
Some patients in the I.C.U. had developed acute kidney injury. They were receiving emergency dialysis through a vein in the neck, including one hospital staff member.
Ms. Figueroa said that as the need for dialysis for critically ill patients increased, the dialysis service had coped by moving machines and supplies from outpatient clinics to the inpatient wards. “We have to pull machines to do bedside” dialysis, she said, “so there are less patients that can be done as an outpatient.”
More than a dozen of the hospital’s roughly 240 patients in its outpatient dialysis clinic have died of Covid-19, according to Dr. Priyanka Singh, one of the attending nephrologists. People with chronic kidney disease may be particularly vulnerable.
Doctors are also employing alternative types of dialysis.
Some New York hospitals, including N.Y.U., Montefiore and Weill Cornell, that are in short supply of the more specialized dialysis machines — needed for what is known as continuous renal replacement therapy — have turned to peritoneal dialysis. It is typically used in patients with chronic kidney disease who want to treat themselves at home. The treatment is not always optimal in hospital patients, especially in those whose conditions are less stable, but “we are trying to give patients something,” Dr. Charytan said.
One problem with peritoneal dialysis in the context of Covid is that it requires putting a catheter in a patient’s abdomen. That makes it difficult to use in those with failing lungs who need proning, a technique in which patients are rolled onto their stomach to help them take in oxygen. Some hospitals, including Montefiore, are placing the catheter toward the patient’s side to help with the problem.
Some hospitals are also struggling to find enough nurses and technicians to provide dialysis, especially after some who were most skilled at providing the therapy fell sick with the virus themselves. “We did lose nurses to illness,” Dr. Murphy of Mount Sinai said. “We’re just getting some of those nurses back, but it’s been a challenge. We’ve exhausted every avenue that we have within the state with regards to being able to increase nursing.”
Doctors say they are wrestling with how to ensure that patients who require immediate care receive it while assessing whether others can wait.
“Now we have to think harder about whether or not that patient truly needs it and can we manage them medically without dialysis another day so we can provide dialysis to someone who more urgently needs dialysis,” Dr. Ross of Montefiore said. “Those are not decisions we like to make.”
Joseph Goldstein contributed reporting.
