This startup wants to take kidney care out of the age of the fax machine

Each year, more than 130,000 people reach kidney failure. It is the most advanced and costly stage of the disease that affects 37 million Americans, 90% of whom do not know they have it.

The tools used to treat those patients, in many cases, have not kept up. In nephrology clinics across the country, sensitive patient information still arrives by fax. Lab results stay in one system while the treating physician works in another. Key data for staff to manually enter electronic health records one document at a time.

“I can walk through the airport and facial recognition lets me through. I can take a picture of the check to deposit it,” Jonathan Lin, founder of Seattle-based Apacendo Health, told GeekWire. “And yet, we’re still managing this disease with faxes and Excel spreadsheets. It’s too old.”

Lin and co-founder Chong Sun believe that AI agents — software that can automatically navigate links, read scripts and take action within existing healthcare systems — can close that gap. Their startup is building what they describe as an AI-powered system for nephrology practices: software that runs in the background, processes incoming faxes, checks incoming data, and handles administrative work that consumes hours of staff time every day.

A disease that hides in plain sight

The US spends more than $150 billion annually to manage the effects of chronic kidney disease, including more than $50 billion on dialysis alone, while the NIH invests $19 per patient in research to understand how to treat and prevent it.

“For the most part, this is a silent disease,” said Dr. Osama Amro, director of nephrology at Swedish Medical Center in Seattle and an advisory board member of the National Kidney Foundation’s Pacific Northwest chapter. “Patients don’t have symptoms of kidney pain or anything that brings them to the doctor, unless it’s late.”

A blood test and urine sample can detect kidney damage years before symptoms appear. But holding patients at that stage requires a level of communication and data sharing that the current healthcare infrastructure is not designed to support.

“We rely on a very tedious process of reviewing data,” Amro said. “The information, believe it or not, comes in faxes, in many places, despite having an electronic medical record. This is not designed to diagnose or manage patients with chronic kidney disease. Many times there is a delay in diagnosing patients who need the first diagnosis in a timely manner.”

A patient with chronic kidney disease can cost the system about $30,000 a year, and the price rises as the patient reaches the end, driven by dialysis and hospitalizations that earlier interventions could have prevented. Meanwhile, a patient without a transplant has less than a 50% chance of surviving five years.

Back office support

Anika Porter has been the director of nephrology for 17 years. As practice director at Global Kidney Care in Houston, he oversees the practical side of the clinic where doctors see 20 to 24 patients a day, spending more time with each patient than providers in many similar practices. The burden of management, he said, falls heavily on employees who don’t usually get attention.

“People are very focused on doctors,” Porter said. “The back office doesn’t get that much support.”

Before introducing Apacendo Health technology, his clinic had two people dedicated to handling faxes. It’s a job that can mean hundreds of documents a day, each requiring manual review and data entry.

Dealing with insurance companies adds another layer of conflict. Payment codes are set, but refunds usually aren’t. Lin described a practice called downcoding, where insurance providers pay much less than what was billed, without notifying the provider.

“Doctors will perform a service, they will charge for that service, and the insurance companies will pay them less, and they won’t even tell them that they are paying at a discount,” said Lin. “Most doctors will never find out that this is happening until they start reviewing their fees.”

“We’re at their mercy,” Porter said of the insurance companies — not to mention that wages are stagnant, and nephrology is among the areas most vulnerable to declining revenue and budget cuts. By 2023, about 52 percent of nephrologists in the United States had international medical degrees – a sign of how few Americans are pursuing this specialty, and how uncertain the future of this field is given immigration policy.

It updates the playbook

Lin spent years working in the dialysis industry before moving into private equity and venture capital focusing on healthcare. Two companies, DaVita and Fresenius, control about 70 percent of the US dialysis market. What Lin observed was a system organized almost entirely around terminal illness, with little infrastructure to support the earlier, avoidable stages.

“Most of the industry relies on a high clinical model, where they believe that if you interact with the patient in a normal way, you can prevent their disease from progressing,” he said. “But the challenge is that it’s very effective. We’re using a playbook from five to ten years ago and applying it to this problem.”

A machine learning scientist, Sun had no prior experience in healthcare. His entry point was his own: his wife, a Navy veteran who became a VA mental health therapist after retiring, spent 7 hours a day on paperwork, leaving only three hours for actual patient care. In 2023, Sun built an app for him to automatically generate time notes from recorded patient conversations. The VA couldn’t accept it, but the experience taught him what it means to try to change health care from the outside.

The two connected through mutual friends and started Apacendo Health in 2025. Lin understood clinical workflow, payer relationships and the political landscape of a fragmented industry. Sun understood how to make software at scale. Their company, now with three employees, operates four nephrology practices across the country. So far, they have raised an undisclosed amount from the Science Fair Fund and angels.

‘Help us manage operations to serve people better’

Apacendo’s product focuses on what Lin and Langa see as an immediate and fixable problem: the day-to-day administrative work that prevents clinical staff from doing anything else.

“We like to work with the system rather than completely change it,” Lin said. “We spent our entire project talking to nephrologists in every community across the country, finding out what they need, and how we can build technology that takes them from where they are to where they want to be.”

Their software creates “digital workers,” or AI agents that work within existing workflows. For example, when a fax arrives, an agent can read it, extract the relevant patient information, and enter it into a database. The company works with its partners to understand their specific pain points.

For a small practice handling about 60 faxes a day, each one takes about five minutes to process manually, which adds up to about five hours of staff recovery time every day. One former customer told Lin that the tool gave him valuable time with his family. Porter, who uses Apacendo at Global Kidney Care, said the bottom line is clear.

“The biggest change we should see is more technology to get help in the office,” he said. “We are not looking for AI to replace humans, but to help us manage tasks to serve people better.”

The initiative’s ultimate goal is to use data to strengthen clinical protocols that reduce hospitalizations or delay disease progression. Identifying which patients are most likely to get worse benefits everyone in the system, Lin said. Amro’s hope is that eventually, the technology can flag subtle signs of kidney disease and deliver that information to the right provider before the window for intervention closes.

“This comes back to patients every day,” Lin said. “We will all grow old in this system. There must be a better way.”