The management guru, Peter Drucker, is said to have remarked, “You can’t improve what you don’t measure.” This certainly applies to continuous biological measures from wearable technologies. In recent years, these cool tools have helped us gain a fuller measure – and therefore improvement – of various aspects of our personal health and wellbeing. Continuous glucose monitors, for instance, are dramatically improving the quality of the lives of people with diabetes. While the obvious value proposition is to eliminate finger sticks and blood draws, studies are starting to validate the non-obvious and more subtle effects from empowering people to drive positive behavioral change. The feedback loop from continuous non-invasive sensors may indeed hold the key to sustainable behavior change, without which we may never be able to truly tame the rising toll and cost of many chronic diseases. 

Proton Intelligence is developing the first ever continuous wearable kidney health monitoring platform, starting with potassium. The kidneys control our potassium levels and potassium controls every single heartbeat. That’s why kidney patients die, not from failed kidneys per se, but from heart attacks. We’ve had no way to get continuous visibility to the dangers of potassium when kidneys start to fail. Nephrologists and kidney care teams around those undergoing dialysis are flying blind today when it comes to the potassium level in their vulnerable patients.

Sahan Ranamukha, biomedical engineer turned CEO of Proton Intelligence, is an entrepreneur in the true sense – he searches for change, responds to it, and exploits it as an opportunity. It is an understatement to say that kidney care, certainly in the US, is going through massive change. Large kidney care players are consolidating, trying to extend their footprint and purchasing power. Nephrology practices are also consolidating and adapting to risk-sharing contracts with payers. Can the continuous measurement of potassium become the key that unlocks and actualizes the promise of value-based kidney care?  Proton Intelligence’s sensor has the potential to underpin and provide actionable data to avoid hospitalizations, rationalize the use of potassium binding drugs, shift dialysis safely to the home, and become an integral part of other such critical changes required for extracting real cost savings from rationalized kidney care management. No wonder then that, in survey after survey with nephrologists, especially those already belaboring under the pressure of value-based contracts, there is clear demand for Proton Intelligence’s wearable. The challenge and the opportunity are huge.

Sahan had just been crowned our “Killer of the Week*” by his very competitive peers when I called him to ask pesky questions about whether he is truly ready to embrace bold business models exploration necessary to maximize the value of his potassium sensor technology (*more at: IndieBio Killer of the Week Spotify Podcast):

I know that making the world’s first non-invasive potassium sensor is no easy feat. But what makes this a multi-billion dollar opportunity? 

When we initially looked broadly at where potassium levels – whether discrete, semi-continuous or continuous – can drive patient care decisions, we came up with 17 different use cases. That was surprising to us in itself because potassium, unlike glucose or other analytes, is mostly in the background in lab tests today. But when we zeroed in on people with later stage kidney disease, especially those on dialysis, it became rapidly clear that is where our beachhead market should be. 

Isn’t dialysis already a saturated market for innovations?

550,000 people are on dialysis each year costing the system $100,000 each – that’s $55B per year spent managing kidney care today. When we speak to nephrologists, kidney care companies, and payers, they worry that this burden will rise even further despite huge pressures to contain costs. Without question, they are desperately seeking innovative solutions, especially those that help them extract cost savings while also increasing the quality of care. 

So how does one little device upend this cost problem? 

Patients will change their behavior because they will love having visibility into what is going on with potassium (and over time, sodium and other key analytes) in their bodies at all times. That’s why we have the winning technology platform – we are the only ones who can cut this Gordian knot by providing a new stream of actionable data the care team needs to do their thing, while simultaneously empowering patients to take more control of their own health. Nephrology care teams will finally have a veil lifted so they can make smarter and safer decisions. This is what is needed to drive make value-based kidney care actually work and be sustainable in our healthcare system. When we deliver on our promised value, our share will be way more than $1B. And, this is just our beachhead! 

What did you achieve during the IndieBio program?

When we got here, we had a sensor that kinda sorta worked in a simulated interstitial fluid. It was not selective for K+, not biocompatible, and simply too large a form factor to be a viable product. In the last few months, we worked hard to hit our selectivity and biocompatibility specs and also miniaturized our sensor over a 1000-fold. On IndieBio Demo Day, we achieved a world first – we now have the world’s first K+ wearable. My co-founder, Francis Steiner, and I wore it for 8 hours and showed the continuous data stream to the delight of investors as we pitched to them.

What about the business side of things?
During the program, Francis led the way on the business side to engage with the entire kidney care ecosystem. We spoke with hundreds of nephrologists, the biggest dialysis companies, and a handful of chronic kidney disease management companies. We will be starting pilots with a selected few of these. All these discussions have validated and confirmed the criticality of our K+ sensor as a key enabling driver to achieve pareto superiority in the future of kidney care management. I am also happy that investors appreciated our progress and have already filled out our next round.

One thing we noticed you do amazingly well is to recruit and manage a trans-continental team during a pandemic. Tell us your secret to managing teams virtually. 

When we joined IndieBio, we had a small team, including Francis and me, who were based out of Vancouver. We added our third co-founder, Victor, who leads the sensor technical development team in Australia. We also managed to hire away a key hardware development engineer from a CGM company, and he happened to be based in Europe. We are rigorous about ensuring alignment across teams on key goals and resources required for successful execution. We are creating a company culture that thrives on virtual collaboration with flexibility across various time zones, while ensuring strong communications up, down and sideways. It’s still early and there are certainly challenges, but we are laying the foundation for a successful company that is able to tap talent across the globe and execute well under pressure, just as we demonstrated to the world on Demo Day. 

Hear how they outcompeted their peers for the most progress in one week in our Killer of the Week podcast: #1217 – Honey, I shrunk the electrode.