Clinical applications and limitations of large language models in nephrology: a systematic review.

Abstract

Background: Large language models (LLMs) have emerged as potential tools in healthcare. This systematic review evaluates the applications of text-generative conversational LLMs in nephrology, with particular attention to their reported advantages and limitations.

Methods: A systematic search was performed in PubMed, Web of Science, Embase and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies assessed LLM applications in nephrology. PROSPERO registration number CRD42024550169.

Results: Of 1070 records screened, 23 studies met inclusion criteria, addressing four clinical applications in nephrology. In patient education (n = 13), GPT-4 improved the readability of kidney donation information from a 10th to a 4th grade level (9.6 ± 1.9 to 4.30 ± 1.71) and Gemini provided the most accurate answers to chronic kidney disease questions (Global Quality Score 3.46 ± 0.55). Regarding workflow optimization (n = 7), GPT-4 achieved high accuracy (90-94%) in managing continuous renal replacement therapy alarms and improved diagnosis of diabetes insipidus using chain-of-thought and retrieval-augmented prompting. In renal dietary guidance (n = 2), Bard AI led in classifying phosphorus and oxalate content of foods (100% and 84%), while GPT-4 and Bing Chat were most accurate for potassium classification (81%). For laboratory data interpretation (n = 1), Copilot significantly outperformed ChatGPT and Gemini in simulated nephrology datasets (median scores 5/5 compared with 4/5 and 4/5; P < .01). TRIPOD-LLM assessment revealed frequent omissions in data handling, prompting strategies and transparency.

Conclusions: While LLMs may enhance various aspects of nephrology practice, their widespread adoption remains premature. Input-quality dependence and limited external validation restrict generalizability. Further research is needed to confirm their real-world feasibility and ensure safe clinical integration.