Start-Up interviews the inventors behind Ardian, the object of one of the highest priced venture capital-backed medical device acquisitions, and between them, five other medical device companies. The team uniquely brings a perspective of applied physiology, and the integration of systems, to the goal of device innovation. In CHF Solutions, they've addressed heart failure with a device from nephrology, in Cardiac Conetps, heart failure by way of a neurological approach to sleep apnea, and in Ardian, hypertension, by studying the functioning of the kidney.

Clinicians are increasingly recognizing that the combination of renal dysfunction and heart failure appears to hasten the decline of patients with chronic heart failure (CHF), and even to increase their death rates. This is a significant observation because in one million annual hospital admissions for acute decompensated heart failure each year, 80% of patients have some degree of renal insufficiency. Now, several new device companies targeting cardio-renal syndrome hope to attack heart failure from a new vantage point: the kidney.

Dialysis prolongs the lives of patients with end-stage renal disease, but outcomes are still poor, with a 17% mortality rate in the US. Nephrologists and technology developers want to improve outcomes, but the economics of dialysis have stymied innovation. Medicare tightly controls pricing, and developers are hard-pressed to find therapies that increase clinical benefits but not cost. Recently, two major clinical trials in dialysis hint that the benefits of dialysis, as it's currently performed, are approaching their limits. Start-ups now have the ammunition with which to approach a technologically stagnant market. Small companies, however, face daunting competition: three giant players dominate the market, two of which own 40% of the service centers that provide dialysis therapies.