An artificial intelligence-powered virtual nephrologist successfully increased the likelihood that patients with advanced chronic kidney disease (CKD) would want to discuss transplant options with a real doctor, according to a new pilot study. The interactive platform, which can be accessed anytime from a smartphone or computer, provided standardized education on kidney transplantation and showed promise in overcoming common barriers that prevent patients from pursuing this life-saving option.

Why Are Transplant Referral Rates So Low for Kidney Disease Patients?

Despite the well-documented benefits of kidney transplantation compared with long-term dialysis for people with end-stage kidney disease, transplant referral rates remain surprisingly low. Researchers identified several reasons why patients with advanced CKD don't pursue transplants, including limited education about the benefits, fears about the surgical process, time constraints that make it hard to meet with specialists, and inadequate access to nephrologists who can provide detailed information.

The disparities are particularly troubling. Access to kidney transplants varies significantly based on race, income, and sex, meaning some patients face even greater barriers than others. This is where the virtual nephrologist concept emerged as a potential solution.

How Does the Virtual Nephrologist Platform Work?

Researchers at Vanderbilt University Medical Center and the University of Pennsylvania developed an interactive, video-based platform programmed with educational content from the National Kidney Foundation. The system was designed with input from people living with CKD to ensure it addressed real patient concerns.

The platform offers several key features that set it apart from traditional clinical education:

• Customizable Presenters: Patients can select a virtual nephrologist who matches their preferred demographic characteristics, including race and sex, addressing a documented preference many patients have for clinicians who share their background.
• Flexible Pacing: Users can pause, repeat, or skip topics as needed, taking control of their learning experience without the time pressure of a typical doctor's visit.
• 24/7 Availability: The platform is accessible anytime from a smartphone or computer, removing scheduling barriers that often prevent patients from accessing specialist information.
• Comprehensive Topics: The virtual nephrologist covers kidney transplant workup procedures, how long transplants typically last, procedural risks, and strategies for receiving a transplant sooner.

What Did the Study Show About Patient Engagement?

Researchers tested the platform with 148 participants who completed both pre- and post-encounter surveys. The group had a median age of 66 years, 59% were women, and 50% identified as Black. Participants spent a median of 12.6 minutes reviewing a median of 11 topics, with 83% accessing the platform on a mobile device.

The primary finding was significant: participants reported a meaningful increase in their intention to speak with a human clinician about kidney transplantation after using the virtual platform. Mean intention increased by 0.30 points on a five-point scale, moving from a baseline score of 3.7 (between "unsure" and "likely") to a higher level of interest in discussing transplants with a physician. This difference was statistically significant.

Patient engagement was notably high, with 89% showing evidence of active interaction with the platform. Written feedback was overwhelmingly positive, with patients describing the experience as helpful, understandable, and less intimidating than they expected.

How Did Patients Respond to Demographic Customization?

One of the study's most interesting findings involved how patients selected their virtual nephrologist. The data revealed strong preferences for demographic concordance, meaning patients often chose presenters who shared their characteristics.

• Gender Preferences: Among women, 79% chose a female virtual nephrologist, while 46% of men selected a male presenter.
• Racial Concordance: Black participants selected dark-skinned nephrologists 71% of the time, while 55% of non-Black participants chose light-skinned presenters.
• Real-World Disparity: These preferences matter because only about 29% of practicing nephrologists are women, and relatively few nephrology trainees identify as Black, meaning many patients cannot find clinicians who match their demographic preferences in usual care.

"Customizable virtual encounters may help satisfy preferences for demographic concordance that are often unmet in usual care but are feasible to deploy efficiently with AI-based software," the researchers wrote in their findings.

Study Authors, American Journal of Kidney Diseases

Is the Virtual Nephrologist Meant to Replace Real Doctors?

No. Researchers emphasized that the virtual nephrologist was designed to supplement, not replace, the patient's clinical team. The platform provides standardized, accessible education that helps patients prepare for more informed conversations with their actual nephrologist.

"The important distinction is that the virtual nephrologist can reliably provide foundational information at a time and pace convenient for the patient. The virtual nephrologist is available 24/7, never gets impatient, and allows the patient to control the content and topics they want to discuss," explained Benjamin Lok, PhD, co-author and computer scientist at the University of Florida.

Benjamin Lok, PhD, Department of Computer and Information Science and Engineering, University of Florida

The version tested in the study was not designed to answer every personalized medical question. However, researchers have since developed an updated version that integrates advanced language models, provides real-time information, supports interactive questions, and includes safeguards to ensure accuracy.

What Do Experts Say About AI in Kidney Care?

Outside experts view the research as an important proof of concept for how digital tools can improve kidney disease management. Mamatha Bhat, MD, PhD, co-lead of the Transplant AI initiative at the University of Toronto, noted that such programs could provide standardized education between appointments and help patients participate more actively in shared decision-making with their doctors.

"Other digital kidney transplant education programs provide tailored education, but this platform builds on this to have a virtual clinician make the educational experience feel more conversational," Bhat stated.

Mamatha Bhat, MD, PhD, Co-lead of Transplant AI Initiative, Ajmera Transplant Centre, University of Toronto

Regarding concerns about AI in healthcare, Bhat noted that while patients are initially cautious about artificial intelligence, they become more accepting when they understand it as a tool that helps clinicians deliver better care, not as a replacement for human judgment.

The study ultimately demonstrates that well-designed digital tools have the potential to empower patients by making them more informed and better prepared for shared decision-making with their nephrologist, addressing a significant gap in kidney disease education and transplant awareness.