Awak Technologies CEO Suresha Venkataraya believes his company is on the cusp of revolutionising the field of kidney dialysis. Headquartered in Singapore, the medical technology (medtech) firm aims to improve the lives of dialysis patients and their caregivers with an on-the-go dialysis solution.

They have developed a machine — the Automated Wearable Artificial Kidney Peritoneal Dialysis (Awak PD) — which is no bigger than a handbag. It is now in the advanced engineering stage and could one day free patients from being hooked to a 20kg dialysis machine for hours.

Speaking to The Edge Singapore, Venkataraya says: “If you see a dialysis machine 50 years ago and if you see a device now, you won’t see a huge change except probably upgrades to the latest electronics and a 25% to 50% reduction in size. Still, the dialysis machine is very bulky and the plight of the patients is almost the same. So, I thought there’s a huge opportunity to disrupt the industry.”

Awak Technologies was formed in 2007. They are among a group of start-ups worldwide — and the only one in Asia — looking into ways to make wearable dialysis machines. While it is not yet on the market, the Awak PD is lightweight, portable and could cut down the amount of time patients spend on dialysis — which is the treatment patients go through to remove excess water and toxins from the blood, the only option for those with kidney disease.

Awak PD thus acts as an artificial kidney which is to be worn externally. It consists of a pump and a disposable cartridge that filters toxins from the body. Despite its smaller size compared to regular machines, the device can be used for seven to 10 hours a day. It can also be customised to the patients’ needs.

“We are also working on connectivity features… maybe doctors can ‘talk’ to the device directly, or adjust the settings remotely,” says Venkataraya, 38.

According to the company, Singapore is home to some 7,000 dialysis patients, with $175 million spent annually on dialysis treatment. The tiny population here belies the fact that Singapore places fourth in the world for prevalence of kidney failure.

But with the Covid-19 pandemic, patients who visit dialysis centres for treatment might put themselves at risk if proper social distancing measures are not enforced. With their already weakened immune systems, they may also face a higher risk of infection.

“For them, social distancing is a real challenge. They will probably go in a taxi or maybe through public areas, and they’re really vulnerable. They have to go to the centres even if they are 60, 70, or 80 years’ old, there is no alternative,” he adds.

Currently, there are few options for patients with kidney failure. Without an organ donor, a patient may wait nine to 10 years for a kidney transplant. In the meantime, patients have to undergo dialysis at centres for about three times a week, at three to five hours each time. Venkataraya also notes a link between kidney failure and diabetes.

In 2014, about 440,000 Singapore residents aged 18 and above suffered from diabetes, and the number is estimated to grow to one million in 2050. “About two-thirds of kidney failure patients who required dialysis are diabetic… There are more than 400,000 diabetic patients now [in Singapore] and it can grow really rapidly.

As it grows, more and more patients end up with kidney injuries. So, this is a serious problem,” he says.

In the works

Awak Technologies first started its research in 2007 and the technology has been in the works for more than a decade.

When Venkataraya joined the company in June 2017, the prototype had already passed through a couple of stages, including the pre-clinical trials and animal studies.

He succeeded former president and CEO Neo Kok Beng, who had co-founded Awak Technologies with doctors from Singapore and the US.

Venkataraya was previously director for front line care R&D at global medical device provider Hillrom, where for seven years he was responsible for developing and commercialising new products. Venkataraya relocated from India to Singapore in 2008 and received his Master’s in electrical engineering from Nanyang Technological University the following year.

“When I first heard about Awak, I thought it was just another [work of] innovation. But when I did a little bit more research on what exactly Awak is trying to do, I realised that this is going to help millions of patients,” he says.

As CEO, Venkataraya is responsible for raising funds, building the team and overseeing the global expansion of the company. He also oversaw a US$40 million ($52.66 million) advanced Series A round, co-led by Vickers Venture Partners and an unnamed global medical products company, which closed in December 2019.

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The company now employs 50 people across the areas of chemical and engineering R&D supply chain, clinical studies, marketing and finance. Since moving out from Temasek Polytechnic in 2017, the team now occupies a dedicated space at Tuas Lane, complete with laboratories and a small manufacturing facility.

Breakthrough device

In 2019, Awak PD was awarded the ‘breakthrough device’ designation by the US Food and Drug Administration, granting the team some assistance as they ready the device for the market.

Awak Technologies also conducted its first in-human trial of its proprietary tech in 2016, with the help of senior consultant Dr Marjorie Foo and her team at Singapore General Hospital.

The collaboration has spanned a decade, and the latest trial has helped 15 patients receive more than a hundred therapies.

But the company still needs some time before it can hit the market, even though its competitors are close. Media reports indicate that Dutch start-up Nanodialysis expects to launch its wearable PD device in 2022 while Swedish firm TrioMed completed a trial of wearable PD devices with five patients in 2018.

Venkataraya does not want to comment on its launch date “but our aim is to start the next phase of clinical trials in the next 18 months or so … It [will] definitely take some years before we commercialise.” Details like price points are also not yet available but the company is aiming to keep the cost within current treatment options.

Typically, the monthly cost of treatment — including machine rental and the dialysis fluid — is around $2,000.

Venkataraya concludes: “Our treatments are not going to be more expensive than the current treatment modalities. Our aim is not to make it less expensive [but] to bring more value to patients, to give them the freedom and give them their life back.” “[We] see patients living only to dialyse. We want to give them [a better] quality of life so that they can dialyse to live.”