An AI-generated “virtual nephrologist” showed potential to increase the likelihood that patients with advanced chronic kidney disease (CKD) would contact a live clinician to discuss their transplantation options, according to results from a pilot study.

“This trial provides novel evidence of the feasibility of deploying virtual nephrologists to drive engagement about [kidney transplantation] among patients with advanced CKD,” the authors wrote in research published in the American Journal of Kidney Diseases.

Despite the substantial benefits of kidney transplantation compared with long-term dialysis in patients with end-stage kidney disease, transplant referral rates remain low, with troubling disparities in access based on race, income, and sex. Barriers to referral include limited effective education on the benefits of transplantation, fears about the process, time constraints, and inadequate access to clinicians who can provide detailed information.

Enter the concept of the virtual nephrologist, an interactive, video-based platform capable of providing evidence-based information to patients, free of the usual time constraints of a clinical visit. Patients can also select the AI presenter’s race and sex.

The platform was programmed using National Kidney Foundation educational content and developed with input from a focus group of four adults with CKD. It was subsequently tested among 20 patients and caregivers in a nephrology clinic.

Testing a Virtual Transplant Educator

For the single-arm, open-label pilot study, first author Peter P. Reese, MD, PhD, of the Vanderbilt Center for Transplant Science at Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues contacted 1140 patients with advanced CKD who received care at the CKD clinic at Penn Presbyterian Hospital in Philadelphia.

Patients were invited to participate by text or phone invitation. Of those contacted, 652 did not respond and 221 declined. Of the 267 patients who agreed to receive a study link, 148 (55%) completed both the preintervention and postintervention surveys. Participants had a median age of 66 years, 59% were women, and 50% were Black individuals.

They could choose among four virtual nephrologists who appeared to be approximately the same age as the patient and were presented as either a dark-skinned or light-skinned man or woman.

The web-based virtual meetings could take place at any time and were accessible from a smartphone or computer.

The virtual clinician presented kidney transplantation topics in a prespecified order. Patients could pause and repeat information, conclude one topic, or redirect to another. Topics included the transplant workup, transplant longevity, procedural risks, and strategies for receiving a transplant sooner.

After each topic, patients could indicate if they wanted additional information.

Greater Intention to Speak With a Clinician

Participants spent a median of 12.6 minutes reviewing a median of 11 topics. In 83% of cases, the virtual encounter took place on a mobile device.

For the primary endpoint, participants reported a significant increase in their intention to speak with a human clinician about kidney transplantation after using the platform. Mean intention increased by 0.30 points from the pre-encounter baseline score of 3.7 on a five-point scale, representing a response between “unsure” and “likely” to discuss transplantation with a physician (P < .001).

The authors characterized the effect as low or moderate, noting the result “is not surprising given that participants had only one encounter with the virtual nephrologist,” they wrote. “A longitudinal interaction might be required to generate effects of large size.”

Most participants reviewed all 11 available topics, and 89% showed evidence of active engagement with the virtual nephrologist platform.

“The written feedback was positive, with patients describing the virtual nephrologist as helpful, understandable, and less intimidating,” senior author Vishnu Potluri, MD, PhD, of the Department of Medicine, Renal Division, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Medscape Medical News.

However, he noted that “patients who were uncomfortable with a virtual clinician educator may have been less likely to enroll, so that remains an important question for future studies.”

Patients Often Chose Demographically Similar Presenters

Patients frequently selected virtual nephrologists who shared their sex or skin tone.

Among women, 79% chose a female virtual nephrologist, whereas 46% of men chose a male presenter.

Furthermore, 71% of Black participants selected a dark-skinned nephrologist, whereas 55% of non-Black participants chose a light-skinned nephrologist.

Those findings aligned with earlier research suggesting that many female patients prefer clinicians of the same sex and that many Black patients prefer racial concordance with their healthcare professionals, the authors noted.

However, only an estimated 29% of nephrologists are women, and relatively few nephrology trainees identify as Black, according to research.

“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 authors wrote.

Designed to Supplement, Not Replace, Human Interaction

Asked how the virtual nephrologist compared with telehealth programs involving live clinicians, co-author Benjamin Lok, PhD, of the Department of Computer and Information Science and Engineering at University of Florida in Gainesville, Florida, noted that “the virtual nephrologist was designed to supplement, not replace, the patient’s clinical team.”

The platform provides “standardized, accessible education” and aids patients as they prepare for a more informed conversation with their nephrologist, he said.

“The important distinction is that the virtual nephrologist can reliably provide foundational information at a time and pace convenient for the patient,” Lok added. “The virtual nephrologist is available 24/7, never gets impatient, and allows the patient to control the content and topics they want to discuss.”

The version evaluated in the study was not designed to answer every personal or medically individualized question. However, the researchers have since developed an updated version that “integrates large language models, provides real-time information, supports interactive questions, and includes safeguards,” they wrote.

Virtual Nephrologist More ‘Conversational’

Commenting on the research, hepatologist Mamatha Bhat, MD, PhD, co-lead of the Transplant AI initiative at the Ajmera Transplant Centre at the University of Toronto, Toronto, Ontario, Canada, described the study as an important proof of concept.

“Such a program could provide standardized and highly accessible education between appointments and help patients be prepared to participate in shared decision-making,” she told Medscape Medical News.

“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.”

Regarding apprehension about interacting with AI, Bhat noted that “patients are understandably cautious regarding AI use in healthcare initially, but in this study, as in general, became more accepting when they came to understand AI as an adjunctive aid to clinicians to improve delivery of care.”

The study ultimately showed that “well-designed digital tools could better empower patients in their care by being more informed and prepare patients for shared decision-making with their clinician,” she said.

The study was supported by a grant from the Research Initiative on Improving Management of Chronic Kidney Disease at the Leonard Davis Institute at the University of Pennsylvania. The initiative was funded through a gift from Monogram Health. Lok reported receiving royalties from Elsevier and owning equity in Rovex Technologies. Bhat reported conducting research on AI and digital decision-support systems in transplantation.