Nephrology Research in Focus: Insights From Acute Kidney Injury in ICU Patients, Covid-19 in the Dialysis Population, and Chronic Kidney Disease From the NHANES Dataset

Abstract

Background: Kidney diseases are a growing public health concern, often underdiagnosed and influenced by systemic and social factors. Timely recognition of acute kidney injury (AKI) in critical care remains challenging. Dialysis-dependent populations faced elevated risks during the COVID-19 pandemic, while non-traditional factors like poor sleep health are increasingly linked to chronic kidney disease (CKD). This dissertation includes three related studies examining diagnostic accuracy in AKI, disparities in COVID-19 outcomes among dialysis patients, and associations between sleep disturbances and CKD. Methods: Study 1 is a retrospective cohort analysis comparing physician-diagnosed AKI to KDIGO-based diagnoses in ICU patients. Study 2 examines COVID-19 trends and mortality among urban and suburban outpatient dialysis populations in New York during two pandemic waves. Study 3 uses NHANES 2017–2020 data to assess associations between sleep disturbances (excessive daytime sleepiness, snoring, apnea-like symptoms) and CKD in U.S. adults. Results:In Study 1, 54% of AKI cases meeting KDIGO criteria were missed by physicians, especially early-stage cases. Study 2 found ongoing mortality disparities, with COVID-positive status strongly linked to death, despite lower infection rates. In Study 3, excessive daytime sleepiness remained significantly associated with CKD (OR = 1.33; p = 0.018), while snoring and apnea-like symptoms showed weaker associations. Conclusions:These studies highlights the need for standardized AKI diagnosis, targeted responses to dialysis disparities during emergencies, and recognition of sleep health as a CKD risk factor. Aligning clinical practice with public health policy can enhance kidney disease detection and car