Welcome to the Kidneyverse
Start here. This piece explores the vast landscape of unmet needs driving the ideas, innovations, and investments that will shape the future of global kidney health.
Shape the future of global kidney health
Ready to help shaping the future of kidney health? Whether you’re a healthcare professional, innovator, or someone personally impacted by kidney disease, you’re in the right place. On this page, we’re exploring signals across the nephrology landscape—from early detection and prevention to emerging medical devices, drugs, and diagnostics. Our mission is to shine a light on the problems that keep our kidney community up at night—and the reasons we get out of bed in the morning.
This page is both our blueprint and treasure map to help us find our way through the vast expanse and deliver effective, accessible innovation to the one billion people affected by kidney disease across the globe. So let’s explore the future of kidney care, one idea, innovation, and investment at a time.
We begin with the landscape to better understand the diverse needs at hand. Then, we’ll take a closer look at market segments based on their primary functions and endpoints. Finally, we’ll review top trends driving us forward.
After years of building healthcare technology, including a learning company for dialysis patients, I’ve seen firsthand how fragmented healthcare can be—especially as a VA patient myself. That’s why I founded Signals, to create this space to connect the ideas, people, and innovations that will change kidney health as we know it. Thank you for being here with us.
Let’s begin.
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Landscape
The landscape of kidney care consumers is diverse, reflecting varying levels of acuity and unique needs. To provide a comprehensive understanding, we categorize kidney care consumers into four distinct segments: Early Stage CKD, Late Stage CKD, Recent Kidney Failure, and Long-Term Kidney Failure.
Segments and Needs
Early Stage CKD (Stages 1-3b): This stage is often asymptomatic or with mild symptoms. Individuals may not yet be aware of their kidney condition but are at moderate to high risk due to factors like hypertension, diabetes, or family history. They generally manage their health with primary care and need education on lifestyle changes, regular monitoring, and ongoing support to slow progression.
Late Stage CKD (Stages 4-5): At this stage, kidney disease is often undiagnosed or undertreated, with symptoms like fatigue and swelling becoming more apparent. People typically face multiple comorbid conditions, requiring management from nephrologists. Their needs include targeted education to prepare for kidney failure, regular testing, and personalized treatment to slow down further deterioration.
Incident ESKD (Recent Kidney Failure): This stage marks the sudden onset of kidney failure, often requiring immediate renal replacement therapy. Patients have likely not had prior exposure to kidney care and may lack awareness of treatment options. They need prompt education, coordinated care, and support to understand their options, manage symptoms, and transition into long-term care.
Living with ESKD (Long-term Kidney Failure): Individuals at this stage have been living with kidney failure for years, often experiencing multiple treatment modalities (e.g. dialysis, transplant). They are very familiar with the challenges of kidney disease management and require individualized care plans that adapt over time. Living with ESKD isn't just about managing dialysis; it’s about the emotional toll, family dynamics, and the invisible, heavy barriers patients face daily. A multidisciplinary care team, ongoing emotional and social support, and treatment adjustments are essential to managing their condition long-term.
These segments capture a fraction of the breadth of individual lived experience, from those in the earliest stages of CKD to those who have navigated kidney failure for years. Patients within and across those segments have unique characteristics and needs. Enabling a more personalized approach to kidney care delivery starts with understanding individual goals and desires. We map these unique group-level challenges and requirements so that we can reimagine the kidney care journey for individual patients and their loved ones.
It is upon this foundation that we will build our understanding of what’s needed and what’s possible. That’s where care and innovation happen— and where many of you come in.
Market Segments
Now that we have a basic understanding of the complex challenges people face at each stage of kidney disease, let’s talk about potential solutions.
Investment in kidney care, both public and private, has accelerated since the passing of the 2019 Advancing American Kidney Health initiative. The pace and energy has only increased in the wake of the pandemic, driven by outsized investments into areas like population health and value-based care.
While kidney care companies can broadly be defined as those that help consumers understand, manage, or treat their kidney health with the support of healthcare providers or solutions, I have specifically categorized them into 9 primary segments based on their main functions and key outcomes.
Value-Based Care & Care Delivery: Innovations in care delivery models prioritizing care coordination and cost-effectiveness. Key outcomes include patient outcomes, lives served, costs and optimal starts.
Life Sciences & Pharma: Innovations in drug development, life sciences & biotechnology. Key outcomes include effectiveness, regulatory approvals, and IP protections.
Remote Patient Monitoring and Diagnostics: Technologies for remote monitoring and diagnosis of kidney-related conditions. Key outcomes include early detection and treatment, timely interventions, and costs.
Medical Devices: A broad array of hardware solutions from dialysis machines to smart catheters and real-time imaging devices. Key outcomes include regulatory approvals, errors, complications, quality of life, access and costs.
Dialysis Logistics: Dialysis infrastructure includes the facilities, transportation, supplies and lab testing required to perform treatments. Key outcomes include safety, accuracy, attendance, and patient experience.
Transplant Logistics: Technologies and services that enable organ procurement and patient transportation. Key outcomes include organ waste, delivery times, matching efficiency, and patient access.
Artificial Organs: Innovations in artificial organs, including xenotransplants and bioartificial organs. Key outcomes include organ availability, survival times, and patient access.
At-Home Care: Technologies that enable and empower patients to manage their kidney health at home, from dialysis to lab draws and continuous monitoring. Key outcomes include quality of life, discontinuation rates, costs, hospitalizations, and access.
Now that we have the 9 market segments and 4 patient segments within which these solutions exist, it’s time to talk about how, when, and where they come together.
This is where we turn our attention to the forces shaping kidney health today and tomorrow. Below you’ll find a list of top trends, challenges, opportunities, and perspectives to keep top of mind as you navigate the Kidneyverse.
Top Signals
Below is a list of our Top Ten areas of exploration so far on Signals. Under each topic, you’ll find a couple examples of our most read articles, interviews, and discussions.
[1]. Value-Based Kidney Care
The continued growth and momentum in value-based kidney care paints an exciting picture of what’s ahead for providers and patients managing CKD and ESKD. Combined, the companies included in this review have raised > $2 billion in outside capital, serve nearly 1 million patients, and manage over $15 billion in annual spend.
[2]. Kidney Capital: Who, When & What Gets Funded In Kidney Care
Data from 14 of the most active investors in kidney care from idea to IPO shows why, how, and when ideas get funded — and who is backing them. “Kidney Capital” is where great ideas, research, products and teams get funded to build the future of kidney care across the globe.
[3]. 90% of kidney disease is undiagnosed – here's how we might fix it
There are currently 850 million people in the world living with chronic kidney disease (CKD), and CKD is predicted to become the fifth global cause of death by 2040. 90% of people with kidney disease don’t even know they have it. Neither do their doctors.
[4]. We should probably talk about (barriers to) home dialysis
In this section, we talk about how the IM-HOME study reshapes our approach to patient, care partner, and provider-facing barriers to home dialysis. Researchers explored barriers to home dialysis as perceived by patients, caregivers, and providers. The study surveyed a group of 522 participants, including 233 providers, 243 patients, and 46 care partners. We use this spark to re-light an open discussion about moving dialysis home, starting with how patients decide to go home in the first place.
[5] What does the future of transplantation look like?
In this section, we explore the dynamic field of kidney transplantation, from cutting-edge research and emerging technologies to the complex challenges that impact access and outcomes. Topics range from advancements in organ preservation, to policy changes shaping transplant eligibility and waitlists. We also dive into the growing importance of living donor programs and the role of transplant centers in addressing the increasing demand for kidneys. Our goal is to highlight the critical intersection of innovation, access, and equity in transforming the future of kidney transplants.
[6]. How to build (more) peer mentor programs in kidney care
A critical gap exists in the support system for individuals living with kidney disease and those who care for them. This post dives into the potential of peer-to-peer (P2P) mentor programs, their role in overcoming access barriers, and the lessons we can glean from successful programs in other areas like cancer, behavioral and mental health care.
[7]. Remote patient monitoring in kidney care
More than 800,000 Americans are living with end stage kidney disease today, 70% of whom are on dialysis. What if we could help clinicians and care teams monitor patients between dialysis treatments and blood draws, and do so without asking patients and care partners to change their routines or take on additional care burden? That's where novel monitoring solutions enter the fold, paving the way for a healthier, safer and more cost-effective future for dialysis patients.
[8]. How should we deliver kidney care in rural America?
One in five Americans and about 86% of the land area in the United States are considered “rural.” Using lessons from the Zuni tribe in New Mexico and the VA’s growing tele-nephrology program, this Signal unpacks h the multi-pronged challenges of workforce shortages, limited access to specialists, and daunting travel distances in rural America.
[9]. Why it's getting harder (and more expensive) to make new drugs
The FDA approved 55 drugs in 2023. You might be thinking: "More than one a week. That's pretty good, right?" Do you know how much pharma companies will spend on R&D this year? Around $200 billion. But here's the kicker: the number of new drugs approved per billion USD spent on R&D has fallen around 80-fold since 1950. Simply put, it costs a lot more money to make drugs today than it did in the past. This post is about “Eroom’s Law,” and what’s being done to address it.
[10]. The Drug Landscape in Kidney Disease
In the last 3 years, the landscape of treatments for IgAN has completely changed. To be more specific, we have gone from zero approved treatments to three. And there are ten more in the pipeline. In this section, we explore a few of these trends including headlines, new endpoints for immuno drug trials, and a hot button policy debate on protecting patient choice and how we pay for innovative drugs for dialysis patients.
Data Room
We built the Signals Data Room to give you access to the visuals, graphics, and data that bring these insights to life—helping you stay at the forefront of the ideas, innovations, and investments shaping the future of kidney health.
Much of our content is free to download, aligning with our mission to expand the Kidneyverse by making kidney health more accessible and actionable for our global community. Reach out with any updates or requests—we’d love to hear from you!
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