NephroAI

We are solving the problem of late management of chronic kidney disease and poor management of blood pressure in people with chronic kidney disease. 

15% of the adult US population has chronic kidney disease (CKD), a condition which costs the US health system $500 billion annually. One of the hallmarks of managing CKD and slowing its progression to kidney failure (where lifelong dialysis or transplant are required to survive) is controlling blood pressure. The average duration from CKD Stage 3 to kidney failure is 7 years with uncontrolled blood pressure, and 24 years with controlled blood pressure. 

Unfortunately, about 70% of people with pre-dialysis CKD in USA have uncontrolled blood pressure. The figures for marginalized patient populations are even worse. 74.5% of Black people with CKD in America have uncontrolled blood pressure. Unsurprisingly, Black Americans have 5 times higher risk of developing kidney failure than White Americans, and make up 35% of people on dialysis. 32% of the excess kidney failure risk Black people have is attributed to poor management of blood pressure (and blood sugar). 

Additionally, 40% of Black people with kidney failure "crash into dialysis", meaning they were not under the care of a nephrologist more than 4 months before the diagnosis. In Black Americans, late nephrologist evaluation increases their chances of dying of kidney failure by 7 times. It also reduces their already extremely low chance of receiving a kidney transplant. 

Our solution is an AI-enabled clinical decision support tool which does two things:

1.) Predicts an individual CKD patient's time-to-dialysis

2.) Provides personalized evidence-based blood pressure control treatment recommendations

This application works through integration into the electronic health record (EHR) used by kidney care provider. The algorithm provides a risk score for each CKD patient (based on laboratory, vital sign, adherence inputs) on the provider's EHR. The application also performs an assessment of the patient's current blood pressure control treatment plan (medication and lifestyle) as recorded on the EHR and compares it to an AI-generated treatment plan recommendation. It draws the provider's attention to any areas of discrepancy between the patient's current plan and the AI-generated recommendation.

This application ensures that a clear CKD management plan is developed and maintained for each patient depending on how close they are to dialysis, and that each patient is on the most up-to-date (based on treatment guidelines) blood pressure control treatment plan.

The proposed solution will be embedded into our "digital health ecosystem" which is described in this video: 

Given the uneven burden of kidney disease, our solution is targeted at Black Americans.

In addition to the increased risk highlighted earlier, the mean onset of kidney failure in Black people is 59 years old, five years younger than in White Americans. Crucially, the "point of inflection" in kidney decline in Blacks occurs at 35 years old, versus 45 years old in Whites. Additionally, people of African descent have a genetic predisposition to kidney failure. A mutation in the APOL-1 gene has been identified as the culprit which increases the rate of kidney decline in Blacks. As a result of this, the prevalence multiple dialysis patient within a family (measured as the proportion of dialysis patients with one 1st or 2nd degree relative who is also on dialysis) is 25% in Black families, versus 14% in White families.

Our solution will ensure that every patient with kidney disease will receive a comprehensive assessment of their kidney failure risk, and their current blood pressure control treatment plan. This is regardless of the type of insurance they have. This will ensure that they do not "fall through the cracks" and have the required support they need to manage their condition, delaying or preventing progression to kidney failure.

(For any reviewer interested in further understanding why kidney disease is the poster child of health disparity in America, Dr. Neil Powe does a wonderful job of explaining the root causes in this lecture)

The 4 co-founders of our startup are Black and have direct experience of kidney failure in our families. 

For example, co-founder and Chief Medical Officer, Dr. Paula Nwajei, was only 15 years old when her father suddenly developed kidney failure (crashed into dialysis). He received dialysis treatment 3 times a week, every single week, for 15 years until he received a kidney transplant 1 year ago. As a board-certified Internal Medicine specialist, who cares for a multitude of kidney disease patients in downtown Atlanta, Paula has an extremely unique personal and professional insight into the problem we are trying to solve. 

The team is led by Dr. Collins Oghor who has a unique background of MD, MBA and Master of Public Health, which lends a holistic perspective of the problem. We have also built a team of highly experienced software developers, data engineers, and a Nephrologist with over 20 years of experience including seating on boards at the Kidney Disease: Improving Global Outcomes (KDIGO). This ensures that we tackle the problem from a diversity of angles. 

We have signed a partnership with a kidney specialist clinic in Atlanta which has about 70% Black patients, to provide chronic care management and remote patient monitoring services to a subset of their patients for 12 months, starting in January 2024. 

How can we close this gap? How can we bring high quality blood pressure management to a marginalized population that has historically low access to healthcare? These are the types of problems that AI has promise to solve. 

Imagine if every person with CKD had access to an AI-enabled blood pressure treatment recommendation engine through their doctor. Our two-pronged solution serves as a clinical decision support tool for healthcare providers who treat CKD patients. It will assess the blood pressure treatment plan of every CKD patient and generate recommendations on required changes to the treatment plan to comply with the most recent evidence-based treatment guidelines. It also predicts an individual's time-to-dialysis, informing the healthcare provider's choices of therapy and early planning for transplant.  

This solution can be applied at a population level - whereby an electronic health record audit can be performed and patients with sub-optimal blood pressure treatment plans can be identified and contacted. This solution can improve the quality of care provided by doctors and nurses, and give them more time and space to focus on the human side of care. Additionally, in parts of the country and the world where there is a severe lack of specialists, this solution can upskill other healthcare providers, enabling them to give specialty-level care to CKD patients. This potential for global health application is a key differentiator of our solution.

800 million people in the world have chronic kidney disease (CKD). In fact, the World Health Organization labelled kidney disease a "neglected epidemic" and a "silent killer". As global deaths from communicable diseases reduce, global deaths from non-communicable diseases (NCD) are on the rise. For example, the global mortality rate of kidney disease increased by about 40% between 1990 and 2017. Uncontrolled blood pressure is a key culprit in this phenomena, compounded by the lack of access to specialist healthcare. 

To put this in context, Nigeria (a country with over 200 million people and 25 million people with CKD) has less than 200 nephrologists. Our solution can fill a part of this gap, by ensuring that CKD patients all over the world can have affordable access to a personalized, evidence-based and validated blood pressure treatment plan. 

Specifically, our solution addresses Target 3.4 - "By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being." 

The predictive component of our solution uses regression analysis.

We have secured longitudinal data of 24,556 people who developed kidney failure from one of the most reputable healthcare institutions in the USA. This will enable us to build a regression model to predict time to dialysis.  

Our blood pressure treatment recommendation engine will use large language models with data from the Kidney Disease: Improving Global Outcomes (KDIGO) "Blood Pressure in CKD" guidelines. We will also leverage a partnership we have with the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS) which possesses longitudinal data of over 30000 patients from 5 countries. We also intend to build data partnerships with the American Society of Nephrologists to improve the quality of the models in the future.  

We are ensuring ethical and responsible use of AI in our work by first composing an AI ethics committee within our organization to develop a charter & code of ethics to guide data collection, management and AI application in our organization. In addition, we are committing to publishing openly the methodology and development of our algorithms, as well as giving open access to healthcare providers in low-income settings. 

We are committing to constant monitoring of our AI and publicly reporting any bias we observe.

We are demanding that all staff in our organization who deal with any form of patient data undergo HIPAA data privacy training every 3 months.  

We aim to impact 500,000 CKD patients in the next five years. We aim to do that by starting small -- building partnerships with Nephrology clinics in the United States. Our first partnership is in Atlanta and begins with giving access to our digital health coach to 500 patients. We aim to replicate this type of partnership with 9 more clinics by the end of 2024. This will bring us to 5,000 CKD patients. In 2025, we will begin providing (free or heavily subsidized) access to our technology to low income countries, through partnerships with global health organizations, while continuing to sign more partnerships with clinics in the United States. 

Full-time: 3

Part-time: 5

Contractors: 3

3 years

Our founding team is comprised of 4 people of African descent. We draw deeply on our experiences as minorities to ensure that we provide an organizational space that is diverse in race, gender, etc. We have an advisor who helps us specifically in this ambition.

We have built a Credo which emphasizes the importance of diversity, equity and inclusion and serves as a guiding light in all we do - from recruitment to client development. 

Our executive team is set up as follows:

• Chief Executive Officer - responsible for implementing the company vision, fundraising, recruitment and actively involved in development of partnerships, and public relations
• Chief Technology Officer - oversees the development, rollout and maintenance of our proprietary technology. Also, involved in sourcing third-party technological tools 
• Chief Finance/Operating Officer - oversees non-dilute grant applications, management of fundraising processes, bookkeeping, projects execution, human resources processes
• Chief Medical Officer - oversees clinical elements of technology development, manages clinical partnerships, oversees patient advocacy

In addition we have 2 advisors who currently support and play the role of:

• Chief Scientific Officer - supports research and development of AI and clinical decision support tools
• Chief Product Officer - supports product development and implementation

We also have a full-time staff who is:

• Director of Partnerships - oversees sourcing, outreach and closing of partnership agreements, manages partner relations in conjunction with CEO

Our operational plan consists of building 

We are raising investment capital through Simple Agreement for Future Equity. 

Additionally, beginning in January 2024, we will be receiving revenues from paying customers. 

Our go-to-market revenue model involves helping small and medium-sized (3,000 - 7,500 CKD patients under care) Nephrology practices benefit from Center for Medicare Services (CMS) billing codes for Chronic Care Management (CCM) and Remote Patient Monitoring (RPM). We assume full responsibility for out-of-clinic CCM and RPM services for a subset of a clinic's CKD patients. This service enables the Nephrologist (billing practitioner) to claim reimbursement from CMS for our services under the relevant CCM and RPM codes. 

Our compensation is 50% of the clinic's CCM and RPM services reimbursements. For a typical practice with 3,500 CKD patients, providing CCM and RPM to 400 patients can generate additional annual revenues of $600k for the clinic, translating to $300k in annual recurring revenues (ARR) for Collogh Cares. Therefore, the average value of each partnership we sign with a Nephrology practice is $300k annually. 

We currently have one clinic partnership, commencing in January 2024 - a 1-year paid pilot with clauses for multi-year renewals. We are targeting two additional clinics by the end of Q1 2024, bringing us to a projected ARR of $1M. This objective is the current focus of our business development efforts. 

Our current operating costs are $250k annually

We estimate operating costs of $750k next year, broken down as follows:

- Research & Development (inc. AI dev.) - $450k

- Business Development - $100k

- Regulatory, Quality Management System & HIPAA - $200k

We are seeking funding of $100k. All of this funding will go towards building and testing our algorithm. We will utilize other sources of funding (such as equity financing and non-dilutive grants) to complete this funding for algorithm development and business development.

We will be most excited about the mentorship element of the Cure Residency program. As a team of 4 young Black, first-time tech founders, there are not many who look like us that we can look up to for guidance on how to build and scale a technology solution. The Cure Residency can give us access to mentors in various aspects of venture building, whose wisdom and counsel could make the difference for us.

Additionally, as we look to build partnerships with various health organizations in the United States, access to the Cure Residency network will be crucial to our ability to scale.