NYMC Student Theses and Dissertations

Date of Award

5-28-2025

Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Dr. Adam Block

Second Advisor

Dr. Savneek Chugh

Third Advisor

Dr. Kenneth Knapp

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 care

Keywords

acute kidney injury, chronic kidney disease, KDIGO, COVID-19, dialysis, excessive daytime sleepiness, NHANES, public health, nephrology

Disciplines

Clinical Epidemiology | COVID-19 | Medicine and Health Sciences | Nephrology

Available for download on Thursday, May 28, 2026

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