An Interactive Virtual Nephrologist to Engage Patients With Advanced CKD About Transplantation

Despite advantages in survival and quality of life with kidney transplantation (KT) compared with other treatments for kidney failure requiring dialysis, many patients do not receive sufficient information about KT or have concerns about it. New artificial intelligence capabilities enable the creation of virtual agents to supplement human efforts to engage patients in regard to treatment options.

Single-arm, open-label trial with the primary outcome assessed before and after intervention.

Adults (age ≥18 and <75 years) with estimated glomerular filtration rate <25 mL/min/1.73 m² in a large health system.

Our group developed the "virtual transplant nephrologist," an interactive, video-based platform to provide personalized education about KT. Meetings could occur at any time from a smartphone with a weblink. Participants first selected the demographic profile of their virtual nephrologist. Participants then self-tailored the encounter, choosing among 11 topics, pausing, changing the topic, and requesting more information.

The primary outcome was the difference in participants' intentions to speak to their doctor about KT before versus after the intervention, assessed on a 5-point Likert-like scale.

Participants had a median age of 66 years; 59% were female, and 50% were Black. Female and Black participants exhibited preferences to select a gender- (P < 0.001) or race- (P < 0.001) concordant virtual nephrologist, respectively. Participants spent a median 12.6 minutes reviewing a median of 11 topics in the encounter. The primary outcome of intention to speak to a clinician about KT increased significantly after the virtual encounter (mean increase, 0.30; P < 0.001).

The clinical significance of the outcome is uncertain.

Virtual clinicians offer a promising path to education and engagement in regard to complex treatments such as KT. This customizable approach to providing high-quality information about KT using a virtual clinician warrants more definitive testing in a randomized trial.

Grant from a nonprofit entity (Leonard Davis Institute at the University of Pennsylvania, supported by a gift from Monogram Health).

Registered at Clinicaltrials.gov with study number NCT06841016.

Many patients with kidney failure requiring dialysis never learn about kidney transplantation or pursue this treatment. This study used artificial intelligence and high-quality information about kidney transplantation to create the "virtual nephrologist," a series of videos that simulate a meeting with a doctor who teaches about transplantation. The study team then tested whether a meeting with the virtual nephrologist increased patients' intentions to speak to their physicians about transplantation. The virtual nephrologist could be accessed on a smartphone or computer at any time and used simple language. Patients chose from 4 nephrologists with different backgrounds and went through topics including the waiting list and finding a transplant center. Participants reported that they were more likely to talk to their doctors about transplantation after using the virtual nephrologist, highlighting a need for more research on applying new technologies like this virtual nephrologist to engage patients about important health topics.