David Kuraguntla, Alio - Spotlight Interview | LSI USA ‘23

The company's remote patient monitoring platform is being developed as an alternative to one-metric devices and consumer-grade sensors (i.e. fitness trackers) that do not capture clinical-grade data.
David Kuraguntla
David Kuraguntla
CEO, Alio



Nick Talamantes  0:14  

Dave, thank you so much for joining me in the studio.


David Kuraguntla  0:16  

Absolutely. Thank you so much.


Nick Talamantes  0:17  

Tell me a little bit about what you're doing at Alio.


David Kuraguntla  0:20  

So Alio is a remote patient monitoring company focused on chronic conditions. In particular, we've had a differentiated platform that can get novel metrics, and no one else can today, with an initial focus on patients with kidney disease.


Nick Talamantes  0:33  

What different metrics are you capturing that your competitors in the remote monitoring space are not capturing?


David Kuraguntla  0:39  

We go after basic vitals as you might imagine. So things like heart rate, temperature, being able to listen to blood flow in a vessel, some things that are out there today already, we really push past that into new arenas, like being able to get hemoglobin hematocrit, which certainly has been out there non invasively but typically a clip on your finger instead of being in more of a patch, easy to use a form factor. And I'm really excited that we recently got the world's first clearance for being able to non invasively, monitor potassium, really starting our cascade into electrolytes that nobody else has been able to get non invasively, so far.


Nick Talamantes  1:14  

Congratulations for that regulatory approval. That's fantastic news. What does this now allow you to capture? What is this data of potassium levels let you tell physicians, what information are we gathering now and looking at.


David Kuraguntla  1:27  

So one of the interesting things about potassium is that if it's too high or too low, it can typically cause you to potentially have a potentially fatal heart rhythm issue. And so that becomes a big issue. It's obviously very expensive, if it shows up for the patient population in terms of selling in the ER, and the ICU. For a patient that shows up with that it's almost a $25,000 hospital visit. All in. It's not just the cost was obviously also the impact on on their health. And in particular, why in kidney disease, we started with it and it's such a big issue is that if your kidneys aren't functioning, as they otherwise should, maybe perhaps in the case of at the end of end stage kidney disease where a machine is effectively doing that work, it may not be clearing the right amount of those electrolytes as electrolytes build up, because your kidneys aren't doing the work, the machine has to kind of go take those off. And if that doesn't happen quite right, or you get too much, maybe you eat something, maybe you eat a banana, right, it sounds silly, but it literally can be driven by just eating many of the common foods that many of us would otherwise take for granted, can actually spike that potassium, and lead to potentially a fatal heart rhythm issue. And that's it can happen that quickly. And that's why it's so important to


Nick Talamantes  2:43  

monitor is this something that by monitoring over time, you can sort of project whether or not the patient is going to have a potential problem that they're going to need to address.


David Kuraguntla  2:53  

So it happens a little bit both ways. So for example, got seven days in a week, most dialysis patients have dialysis me three times, yeah, correct three times a week. So there's always a kind of a 72 hour gap instead of a 48 hour gap. And you will see a spike in hospitalizations, somebody's other issues, maybe high, high potassium on the 72 hour window rather than the 48 hour window. So it can happen relatively quickly. It also does happen chronically as well, decreasing function. Over time, the decreased ability to work with maybe your machine or maybe your blood flow in your access is not as high as it has been in the recent past means that you're not clearing as much of that potassium as you'd like to, for example, that can also be a chronic condition as well. So you're just coming in point one higher every day. And that builds up over the course of a month, if you will, or over 10 sessions is a session. So that's why both chronically, and in a relatively short amount of time, a large increase can happen that can be very detrimental to the patient.


Nick Talamantes  4:00  

So tell me a little bit more about the product that you're developing at Alio. And initially who is this product for.


David Kuraguntla  4:07  

So it's a remote patient monitoring company, we do an entire end to end system. So it starts off with a non invasive wearable, looks like a slightly oversized Band Aid, if you will, that is typically worn on the arm. And we are able to collect that data completely non invasively. There's no needles, no wires, nothing pricking the skin, showerproof, sweatproof, go live your life, do whatever you want to do, you're going to wear this for current versions, about seven to 10 days. Another one that we're releasing later this year will be more in the two to three week range as well right now in terms of how long it lasts and the skin and it's passively collecting that data throughout the day. And whenever you get within range of a little hub that we send home with you. That data is automatically uploaded to the cloud via cellular connection. We run our series of proprietary algorithms on it. And then we push it out into a portal for a clinician, so that they can actually take a look at what may be going wrong. And we certainly realized that there's a lot of, you know, fatigue, I don't want to look at all this data. And so part of the reason where we started was with kidney disease patients. And these patients, especially end stage have a very clear set of guidelines international set of guidelines where it's a few metrics, they really want people to stay within X and Y, and is a very clear clinical workflow for if it's above X to A, if it's below Y to B, so Leo's not creating the Elio metric. We're just saying for some we've talked about potassium a bit for some of the potassium, they wanted to stay between a couple numbers. And we're just telling you when it goes outside of those numbers, if it's too high, or it's too low, and then that way, you can go through the clinical workflow that you would otherwise do today


Nick Talamantes  5:54  

So is the product available today.


David Kuraguntla  5:58  

So we got our first FDA clearance in 2022, for the entire platform, so your wearable, your hub, your cloud infrastructure, and the ability to showcase that to a clinician, along with some of the basic vitals metrics like heart rate, temperature, and the ability to listen to an access or to a blood vessel. We then recently got a our second FDA clearance where we added on the ability to non invasively detect hemoglobin hematocrit and a world's first in potassium as well.


Nick Talamantes  6:27  

How are the sensors then different from maybe what type of sensors go into an Apple watch or an aura ring? How? How do you look at what's happening beneath the skin differently from more consumer devices that are out there on the market today.


David Kuraguntla  6:43  

So for 30 years, people have been trying to really avoid large vessels, large vessels tend to blood vessels inside of the body tend to have a lot of motion artifact, they're deep. How do we get there's there's blood flowing through it. So that's actually been things that for an optical sensor people have been trying to avoid. And we've looked at it if you're gonna go hunt for oil, hunt for the oil well, right? Like, let's go where the data really is. And let's go figure out if we can then solve for the other issues, the motion artifact, ambient correcting for ambient light, we correct for skin color, for example. So everything that Alio does is zero calibration. Soon as you take the patch out of the box, you put it on the patient, it's ready to go. So there's no need for a nurse to come to your home, do a calibration step, do a blood draw to get things up and running, everything's ready to go out of the box. And the reason for that is because we actually go get that data from the major vessel, where everybody's been zigging, if you will, for 30 years, we completely zag the other direction and went after where the data actually is inside of that central vessel.


Nick Talamantes  7:52  

You're not afraid of a challenge. And it sounds like as a result of that you've created a technology that can offer a lot of unique insights to patients with specific conditions. How does the device work if there's no internet or cellular connection,


David Kuraguntla  8:08  

So it's collecting that data passively throughout the day, if the patient goes to work, for example, it's going to keep collecting that data. If they come home, they get close to that hub, that data is automatically uploaded to the cloud. Interestingly enough, we also modified it a little bit. So it actually talks to any hub. So that way, even though it's still there patch, and it's completely de identified HIPAA compliance, encrypted, if you will, all those, those very key pieces that you would expect, it can actually go to any helps you if they're, for example, their hub, something happens to their home. Let's say they go to a dialysis clinic, great, that dialysis clinic has a hub, their data is still going to get uploaded. So we're going to be able to get that a video instead of the current, maybe one photo a month that we get on these patients now actually able to see that video, see how their dialysis is working for them, for example, with a kidney disease patient or others with a chronic disease what has been going on since the last time they saw their doctor


Nick Talamantes  9:03  

So your dialysis clinics today then? 


David Kuraguntla  9:07  

Oh, signed our first contract just right after our first clearance, which is awesome. It's with a partner that has tried out the product a bit before. We're really excited to be moving into their clinic here in the next week or two, and bringing bring it on live. So it's a really exciting time and inflection point for the company. 


Nick Talamantes  9:22  

Congratulations for that. Thank you. Other partnerships in the greater nephrology or end stage kidney disease market. Who else are you working with anyone else?


David Kuraguntla  9:32  

So, there are multiple partners have been we've been working with folks that Intermountain Healthcare we have a partnership with Lifeline Vascular Care that focuses on vascular access. The National Health Service out in the UK was a really critical partner in developing some of our non invasive electrolyte monitoring. So it's been really great to build out those sets of partnerships. And it's been nice to start converting some of those into into contracts as well and going commercial Yeah,


Nick Talamantes  10:00  

I bet. So coming back to the biometrics that you're looking at maybe looking into the future, you've got potassium data now that you're pulling into your platform and making sense of for patients and providers, what are some other biometrics that are sort of on the forecast for you guys to start tackling? And what information is that going to provide to people.


David Kuraguntla  10:21  

So if you look at chronic conditions, and chronic cardiovascular conditions in particular, once again, going beyond your basic vitals is certainly important, pushing that into broad hemodynamics. And then we think electrolytes, as well can help you manage drugs for your patient manage their disease in a more remote fashion without needing to get data. Only when you see your clinician and do a blood draw, for example, once a month, once a quarter, these are things we can certainly tackle and help move forward. So for us, in terms of something like hemodynamics, or going into blood pressure, and comparing that against a radial arterial line in an ICU, we're very comparable to a radial arterial line now. So we're getting true systolic or diastolic blood pressure, not just a trendline. And you don't need a nurse to go to your home, or you have to go to see a nurse maybe multiple times a month to calibrate it, which is certainly important. I think if we then go into somewhere like looking at whether the other blood is flowing through an actual vessel, just starting off at some of your basics, like is there a flow or not, it's really important, then moving that into is this flow abnormal. And we've already seen data around we're comparable to a duplex ultrasound, which is a very slightly large machine, that you have to have a trained technician go and tell you what the actual flow is within your vessels, if you can instead just do that non invasively. That's, that's incredible. And then last, but not least, you know, not just potassium is electrolyte. There's an entire panel behind that. Other things like sodium, urea and creatinine, which we believe are certainly possible, with our platform to be able to get really giving you a comprehensive view of the things that you need to manage for chronic cardiovascular conditions and cardio renal conditions.


Nick Talamantes  12:06  

So safe to say that following reno, you're going to be probably looking at the wider cardio market heart failure, I imagine, could this device then become sort of the standard of care for continuously monitoring patients who are either at high risk or currently been diagnosed with chronic heart conditions?


David Kuraguntla  12:25  

So I certainly think that there's a interesting opportunity from that overlap. I mean, I mentioned cardio renal, and there's a strong overlap between kidney function and, and heart function in terms of especially how much fluid is your heart capable of pumping around your body, right. And so I think those two things are very much interrelated. And being able to see these massive fluid shifts on these patients is certainly very interesting. And it's given us an interesting profile and where fluid goes in the body. So I think there's certainly a unique set of capabilities that we have, I think there's also opportunities to partner with other companies that are in the space, that are certainly there, whether it's an implantable or whether it's another, perhaps another wearable as well, to give you that comprehensive view of the patient. But I think really our target market, and I think, a highly underserved market that has been often neglected, where there's not where folks have been, I think, focus maybe more on that heart failure side. And that kidney disease market, I think we stand alone and have a really unique opportunity to make an impact there.


Nick Talamantes  13:30  

Yeah, I would agree with you. I, I'm curious, what how are these patients currently being monitored in the ESKD de market?


David Kuraguntla  13:39  

So what we've seen over the last, say 30 or 40 years, is, we know that we have to monitor these patients somehow, that's led to almost anywhere in the world. It's federally mandated to get maybe one or two blood draws per month, getting a sort of imaging study, perhaps once a month, or once a quarter. But those are just a brief snapshot. And so what folks have realized is, there are opportunities to reduce the number of hospitalizations because these patients are getting hospitalized on average twice a year, I spend maybe over a week, 10 days, 11 days in an ICU. This is incredibly expensive, as you might imagine, it's happening so frequently. And it's often happening for things that we know such as their axis is going to fail, their potassium is going to be too high or too low things that are we like to call preventable. So with that in mind, there have been lots of interesting strategies to try and tackle this. There are certain countries that actually mandate a blood drop before and after every dialysis session. We saw one of our partners with the National Health Service in in the UK and the Northeast of England, actually hired nurses to drive the patient homes, sometimes up to 50 miles each way just to get a blood draw on their off dialysis days. And they saw this reduces their hospitalizations but as you might imagine, that is not a very scalable, low cost solution to to tackling the problem. And so they put out an RFP, asking is there anybody else out there that can do it, we answered the call and have built a really amazing partnership. But I think that's how people are looking to solve the problem. You've seen others that are taking on I'll say, kind of the old world, if you will, which isn't gonna send you a BP cuff and a pulse ox and et cetera, et cetera, et cetera. And it's just too much, and the patients aren't using it. And I think being able to just wear a wearable get all that data is certainly meaningful. 


Nick Talamantes  15:34  

That's great to hear about your partnerships, the NHS as well, they just the list keeps growing just from this interview alone. And it's great that you guys are being recognized for the terrific work that you're doing. You completed a series C correct? What is that round going to let you guys do and where is it going to take you?


David Kuraguntla  15:50  

We're really excited about the partners that we've had on on the capital side as well. They've built some amazing companies to date. And I think they really wanted to ensure that we were able to go launch into our first several customers showcase that early traction, obviously allowed us to get our second FDA clearance as well and really get get the flywheel up and running. And then we expect to be able to go back on the capital markets, perhaps later this year, for growth round to really turbocharge the opportunities that we have in front of us.


Nick Talamantes  16:23  

So is that what brings you to LSI this year, then you're you're sort of networking, putting the feelers out there. 


David Kuraguntla  16:28  

Yeah. As always, it's developing relationships, letting folks know that you're, you know, meeting and potentially exceeding your milestones that you've told them that you're going to hit is always a great way to continue building those relationships and move forward.


Nick Talamantes  16:40  

Dave, thank you so much for joining me in the studio. I wish you the best of luck with the rest of the meeting.


David Kuraguntla  16:45  

Thanks so much. I appreciate it.


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