The interview with Kathleen Smith, conducted on June 17, 2015 by Dr. Dugan W. Maddux as part of the Nephrology Oral History Project, offers a compelling firsthand account of the evolution of kidney disease care in the United States. Smith, a nurse whose career began in the early days of dialysis in the 1970s, reflects on her journey from bedside patient care to leadership roles in dialysis management, healthcare policy, and national advocacy. Through her experiences, she provides valuable insight into the development of dialysis technology, the challenges of early renal care, and the critical role nurses have played in shaping the field of nephrology.