In Conversation with Aaron Chang, CEO of Renalert – Engineering a Global Paradigm Shift to Prevent Acute Kidney Injury

Every entrepreneur has a “founder’s story” that serves to build the unique framework for why they are just the right person to solve a specific problem. For Aaron Chang, CEO of Renalert, that story began at Johns Hopkins University in the Masters of Bioengineering Innovation and Design program.  Rather than choosing an area of specialty from a book, the program has a unique method of teaching their students. The students are sent to the hospital on rotations with one, not so simple, task. Return with a bioengineering problem to solve. Chang returned with a whopper of a problem to solve; a “silent killer” in fact. During cardiac surgery patient’s kidneys can be acutely injured by inappropriate regulation of hemodynamics. This problem is not the fault of the doctors but a problem related to the lack of information to indicate in real-time the appropriate parameters (for example, blood pressure) patients need to maintain during surgery. Chang set out to solve this problem for his class project.

So how did Chang go from student to CEO? He just hit FastForward.

FastForward with Renalert

FastForward, a part of JHTV, is Johns Hopkins University’s answer to the rapid development of technologies created by their students and staff. Its half tech transfer office, half incubator. In 2017 FastForward helped start 18 companies, one of them being Aaron Chang’s company, Renalert. Chang credits much praise to the program and sees FastForward as another co-founder on the team. While Aaron was concentrating on his technology, FastForward helped him handle the unfamiliar and often complicated steps like incorporation, navigating the patent process, legal services and networking to attract the right investors or collaborators. Leaders like Brian Stansky, Mark VanderZyl, Jorge Aquino, Megan Wahler and access to academic resources, like interns, make FastForward a truly valuable asset to an emerging company. Since FastForward was invested in the company, Chang was very willing to trust the team with some of the heavy lifting while he continued to develop the technology

Chang comes from an engineering background which he credits for teaching him how to be resourceful when solving problems, an important attribute for running a successful startup.  Reflecting on his engineering days he shared, “Back in the day when designing prototypes for other medical devices we never had all the resources we really needed, so we would ‘Macgyver’ our way around it to get the product done and the result we needed.”  Now as a startup CEO he might not have all of the funding a typical startup might need to run clinical trials, but Chang knows how to engineer resourceful solutions. He recommends to look at the incentives that drive the partners you need to work with and align your company with them.  For instance, he knows that the researchers they partner with want to publish, and the OEM partners they work with want to expand their markets. By aligning those incentives you can find ways to work together that benefit each party, without money being the only value exchange on the table.

Outside of being resourceful and the FastForward team, Renalert has had help from the Maryland startup ecosystem. “Biohealth Innovation has been really helpful” shared Chang. “They are like the eyes and ears hovering over the region. They know who to talk to and have been really good at connecting us with the right people.” He also credits BHI for helping them to hone their pitch by coaching them on getting out of the weeds, and focusing on getting their story across. One of the best networks for Chang has been the other founders like David Narrow of Sonavex who has been great to give feedback and bounce ideas off of, Kevin Colbert of Glyscend and now LifeSprout, Kevin Keenahan of Tissue Analytics and many others. Once the commpany became part of the TEDCO family through the MII program they expanded their ‘Founders Network” even more and gained the additional resources and support that they needed to help them solve this big problem.

The Depth of the Problem

Acute Kidney Injury (AKI) often occurs during cardiac surgery. The reason is simple. Doctors have few mechanisms to manage a person’s hemodynamics based on anything other than general guidelines. Unfortunately, every person is different. Chang describes the kidneys as, “ holding their breath” when, for example, the necessary blood pressure is out of scope with what an individual requires. It is easy to imagine how kidney injury can occur over a 3-hour surgery. Even slight kidney injury (stage 1 of 3) can increase 5-year mortality rates by 2.2 times. There are also acute consequence. AKIs which occur during surgery increase hospital stays by 3.5 days on average. These statistics point to a dire problem which Renalert is close to resolving.

It’s the sheer magnitude of the scope of morbidity and mortality around this problem that drives Chang. “Acute Kidney injury is one of the largest health issues you never hear about. It’s a silent killer not talked about much outside of the hospital” Chang said. “However, it’s associated with more deaths than heart failure, prostate cancer, breast cancer, diabetes combined every year.”  This was surprising to Chang when they first began investigating it and it really opened their eyes to the potential impact on the patients and the healthcare costs that they could make. “It’s easy to get swept up in the buzz of the startup culture, which is exciting and challenging” Chang reflected. “That’s all good, but if you do all that without affecting patients, it’s not worth the time in my mind. Seeing the impact we can have on patients is what gets me up in the morning.”

Fueling Growth & Investment with Promising Data

After receiving an MII grant through TEDCO Renalert was able to perform proof of concept studies. These studies measured urine output in correlation with other biometrics as well as length of stay. After initial testing, Chang is,“Seeing good data, and thinking about next steps.” Renalert hopes to use their technology in the future to do more than just monitor urine output and biometrics. The same technology will soon provide doctors with real-time feedback to influence blood parameter changes specific to individuals. These ongoing studies demonstrate Renalert’s ability to identify kidney stress prior to AKI. After being present for 90 surgeries, Renalert is looking forward to fine-tuning their product and creating actionable real-time data for doctors. For now, Renalert is raising a $600,000 round to take them to their next major milestone.

What is so remarkable about what Chang and his team are doing is that they are actually changing the paradigm of AKI from a passive treatment approach to an active preventative approach.  Therefore, instead of waiting for a patient to report symptoms after surgery, Renalert intervenes to prevent AKI in the first place. One of the things Chang is most proud of so far in this journey is, “Seeing that something we worked on here at Hopkins can affect global agendas.” They witnessed this first-hand last year at an International Conference in Italy, the Vicenza Course on AKI & CRRT, where they got to see a presentation by the people that define the threshold on AKI. Because of Renalert’s presentation, they saw the shift in the international conversation from ‘AKI, and what do we do about it?’, to ‘Acute Kidney Stress, and how can we detect the precursors to it?’  Renalert’s MedTech is a true market disruption that started as a ripple here in the Baltimore harbor but is now causing waves that are being felt all around the world.

The Heart of a Maryland Entrepreneur

Chang is a fun hearted entrepreneur whose wit is as sharp as his analytical thought. What drives him is the impact that Renalert can have on patients lives and he wants to create a meaningful company that makes a difference globally. He speaks highly of the Maryland ecosystem and the organizations like FastForward, BHI, and TEDCO which helped him along the way. His gratitude and excitement for the resources being developed to support emerging companies within Maryland are reflected best by his final remarks;  

“Thank you to all the people who have helped us. There are too many to list. Renalert is just one company in this region. There are a lot of really great companies. Some founded by friends of mine. When you help one of us, you help all of us. Thank you to everyone and continue building up the ecosystem.”