Fund of the week: NKF Innovation Fund

Overview of NKF's Venture Philanthropy Model

The National Kidney Foundation (NKF) Innovation Fund is a venture philanthropy program launched in 2022 to catalyze innovation in kidney health. Unlike traditional grants, this impact-investment fund uses donations from major benefactors to invest in early- to mid-stage companies developing breakthrough kidney disease therapies. The goal is to accelerate new treatments for kidney disease by providing "venture-like" funding with any returns reinvested into further research. In NKF's words, the fund aims to "fundamentally disrupt the fight against chronic kidney disease" by closing the funding gap that leaves many renal innovations stranded in the "valley of death."

Investment Thesis: NKF targets companies addressing the full spectrum of kidney care – from prevention and diagnostics to dialysis and transplantation. Its mission is to prevent kidney disease, eliminate the transplant waitlist, and improve dialysis patients' lives. In practice, this means focusing on patient-centric innovations such as artificial kidneys, portable dialysis devices, infection-control technologies, xenotransplantation, and organ preservation solutions. By leveraging NKF's deep clinical expertise and patient networks, the fund not only provides capital but also guidance on regulatory pathways, reimbursement, and clinical trial design. This "blue team" perspective emphasizes that NKF is uniquely positioned to help kidney startups navigate hurdles and align products with patient needs.

Structure and LPs: The NKF Innovation Fund is fueled by philanthropic contributions. Donors receive tax deductions and the knowledge that "any financial returns will be reinvested in more research and innovation", rather than pocketed as profit. In essence, NKF has adopted a model pioneered by other health charities (such as the Cystic Fibrosis Foundation and JDRF) to spur industry R&D for an underserved disease domain. No fixed fund size has been publicly disclosed, but NKF noted early on that the fund was "already attracting interest from major donors" in 2022. This open-ended, mission-driven fund structure means NKF can deploy capital flexibly as donations come in, rather than operating a closed-end fund with AUM. However, this also implies the fund's scale is modest relative to peer initiatives – likely in the tens of millions USD range – given that it has made about 10 investments over four years and has not announced any 9-figure capitalization.

Importantly, NKF takes an equity or royalty stake in portfolio companies rather than issuing grants. Deals are structured so that NKF may hold stock equity and/or negotiate royalty rights on future product sales. This ensures that if a therapy succeeds commercially, NKF shares in the upside (as a return to its mission). It's a patient-focused impact model: financial returns are not an end in themselves but a means to fund more innovation. Still, this approach carries venture-style risks – investments could fail clinically or commercially, potentially yielding no return. The red-team perspective highlights this risk: NKF is essentially using donor money to play in the high-risk biotech startup space. There is no guarantee of success, and the fund's IRR (internal rate of return) is currently indeterminate with no full exits as of early 2026 (though one early acquisition suggests promise, discussed later). DPI (distributions to paid-in) capital also remains effectively zero so far, since any returns would only materialize upon a company exit or licensing deal and would be recycled into new projects. NKF's bet is that even a few wins will justify the portfolio approach – both by improving patient outcomes and by generating cash to reinvest.

Portfolio Breakdown: Investments and Scientific Innovations

As of February 2026, the NKF Innovation Fund has invested in approximately 9–10 startup companies spanning a broad swath of kidney disease challenges. These investments reflect NKF's three strategic goals: (1) Prevent and detect disease earlier, (2) Transform dialysis, and (3) Increase transplant access. Below, we analyze key portfolio companies grouped by their scientific focus, highlighting the blue-team case for their impact and any red-team considerations about challenges.

Transplant Preservation & Logistics

Several NKF-backed startups tackle the critical shortage of transplantable kidneys by improving how organs are preserved, transported, and utilized.

34 Lives (Renovera)

A startup aiming to "reset the clock" on donated kidneys. 34 Lives is developing a proprietary ex vivo perfusion process that rehabilitates donor kidneys and extends their viable out-of-body time. By warming kidneys to body temperature, evaluating function, and infusing nutrients, the company reports it can add "an additional 20 hours of viability" to donor organs. Given that nearly 30% of recovered kidneys are discarded, often due to time constraints, this technology could significantly reduce wastage. NKF's October 2022 investment accelerated 34 Lives' preclinical work in hopes of increasing the organ supply and saving lives.

🔵 Blue Team: This directly attacks the transplant waitlist problem with science (organ reconditioning) – a potentially high-impact innovation if it proves out.

🔴 Red Team: Normothermic perfusion systems are complex and costly; scaling them to routine use will require convincing transplant centers and securing FDA approvals. But NKF's support lends credibility and patient-advocacy weight to drive adoption if efficacy is shown.

Northernmost

Announced as NKF's "first investment of 2025", Northernmost Medical is a Canadian company developing the NoMo™ Kidney Pump, a next-generation portable machine perfusion device. Today, 71% of donor kidneys still ship on ice in static cold storage, an outdated method that can damage organs and limits preservation to ~20–30 hours. While traditional perfusion machines exist, they're "too large, unwieldy, and expensive" for routine door-to-door use. Northernmost's NoMo pump is a small, smart perfuser designed to accompany a kidney from donor to recipient, eliminating the need for ice coolers entirely. By continuously circulating preservation solution and providing real-time data on organ viability, it could cut discard rates in half and improve transplant outcomes. NKF's February 2025 investment aligns with its strategy to "ensure more kidneys reach patients in optimal condition", addressing a major bottleneck in transplantation.

🔵 Blue Team: A logical complement to 34 Lives – one extends organ life via rejuvenation, the other via better transport technology.

🔴 Red Team: The device faces competition from established organ-preservation firms (e.g. Paragonix Technologies) and will need to demonstrate clear superiority and cost-effectiveness. Gaining widespread OPO (Organ Procurement Organization) adoption can be slow.

BMI OrganBank

Another transplant-focused investment came in late 2025, when NKF backed BMI OrganBank – a U.S. company pioneering room-temperature machine perfusion (RTMP) for kidneys. BMI OrganBank's portable perfusion platform, which recently earned FDA Breakthrough Device designation, keeps kidneys at room temperature while perfusing them with oxygenated solution. This intermediate temperature (between cold and body-warm perfusion) can allow functional assessment of organs and longer preservation times. By enabling viability testing, the tech could help transplant surgeons decide whether to use marginal organs and ultimately "expand the number of viable organs available." NKF's September 2025 investment is funding BMI's upcoming clinical studies.

🔵 Blue Team: Attacks the same problem as Northernmost but with a novel approach – room-temperature perfusion could simplify logistics and improve organ evaluation. If successful, it might reduce the ~90,000-person kidney waitlist by making more organs transplantable.

🔴 Red Team: Decades of transplant practice have favored cold or normothermic perfusion, so "room temp" is somewhat unproven. It's encouraging that the FDA granted Breakthrough status, but clinical data will need to show improved outcomes.

ZeitLife

In late 2023, NKF invested in ZeitLife Transplant Innovations, a company led by the same entrepreneur behind Northernmost (CEO Ron Mills) and focused on "modernizing kidney preservation and logistics." ZeitLife brings engineering and design expertise to improve organ transport workflows and perfusion fluids, aiming to enable sharing of organs over longer distances and ensure every kidney is preserved with state-of-the-art methods. The overlap of leadership with Northernmost suggests a synergy – possibly ZeitLife works on the software, process, and fluid formulation side, while Northernmost provides the hardware.

🔴 Red Team Note: NKF doubled down on a single team's ventures (ZeitLife and Northernmost) in a short span. Is this over-concentration, or does it reflect limited deal flow in the niche? Nonetheless, given NKF's mission to "eliminate the transplant waitlist," bolstering entrepreneurs tackling organ logistics head-on fits the thesis.

Dialysis & Home Care Innovations

NKF is equally focused on transforming dialysis, which has seen little fundamental improvement in ~50 years. Two notable investments aim to make dialysis safer, more portable, and more accessible.

Kuleana Technology

The NKF Innovation Fund's inaugural investment (March 2022) was in Seattle-based Kuleana, a University of Washington spinout building a groundbreaking portable hemodialysis device. Kuleana's system – codenamed "AKTIV" – does not require connection to an external water source or large sorbent cartridges, a dramatic departure from traditional dialysis machines. Instead, it uses novel biomaterials and a proprietary photo-oxidation process to continuously regenerate dialysate, breaking down waste products like urea into inert compounds. In lab tests, a prototype removed ~15 g of urea (a full day's worth) using just 1 liter of fluid over 24 hours, thanks to a titanium-dioxide nanowire catalyst activated by light. This suggests the potential for a truly "waterless" or minimal-water dialysis machine – one that could fit in a carry-on suitcase and run on battery power, enabling "whenever, wherever" dialysis for patients.

For patients, such mobility would be life-changing, liberating them from thrice-weekly clinic visits. NKF's support for Kuleana is a bold bet to "radically transform" a therapy that "looks almost identical to 40 years ago." NKF's funding helped Kuleana win attention – the company later secured a $4 million Department of Defense grant in 2023 to conduct animal trials of its artificial kidney technology.

🔵 Blue Team: If Kuleana's device succeeds, it could dramatically improve quality of life and outcomes. The U.S. has some of the worst dialysis outcomes despite spending the most.

🔴 Red Team: Developing a new dialysis machine is extremely capital-intensive (easily $100M+ for R&D, trials, manufacturing). Large dialysis corporations and device makers dominate the market and may be slow to adopt or even hostile to disruptive tech. Industry incumbents have been known to acquire and "shelve" novel dialysis innovations that threaten their consumables-based profit model. NKF's CEO Kevin Longino has openly acknowledged the challenge of attracting investors in dialysis because "several hundred million dollars" are needed and the existing reimbursement system disincentivizes change. As of 2025, Kuleana was aiming for first-in-human trials by 2026–2027 – a timeline that underscores both progress and the long road ahead.

Relavo (PeritoneX)

Relavo is a young, female-founded company (CEO Sarah Lee) that NKF invested in to tackle the main drawback of home peritoneal dialysis (PD): infection risk. Only ~10% of end-stage kidney patients use PD, even though dialyzing at home offers greater lifestyle flexibility and is cost-effective. The biggest barrier is fear of peritonitis, a dangerous abdominal infection that affects nearly 30% of PD patients per year. Relavo's solution, PeritoneX®, is an inline device that automatically disinfects dialysis connections during PD setup. It fits into the fluid tubing and uses an internal disinfection mechanism each time the PD catheter is connected, killing bacteria before they can enter the peritoneal cavity. Lab tests showed >5-log reduction in bacteria introduced at the connection site. Patients can even leave the PeritoneX connector in place between exchanges, reducing touch contamination events.

NKF's investment in early 2023 aimed to help Relavo finalize development and pursue regulatory clearance so that home dialysis becomes safer and more appealing.

🔵 Blue Team: A classic "low-hanging fruit" innovation – it doesn't require re-inventing dialysis, just making an existing therapy (PD) more accessible by mitigating its biggest risk. If Relavo's device prevents infections, it could encourage thousands more patients to choose PD, advancing NKF's equity goals (rural and disadvantaged patients especially benefit from home therapies).

🔴 Red Team: Relavo still must prove in clinical trials that its connector actually reduces peritonitis in real-world use (lab efficacy doesn't always translate to outcomes). There may be challenges in convincing large dialysis providers to adopt and train staff on the new connectors.

Encouragingly, Relavo has gained non-dilutive support – the company won a $1 million NSF SBIR grant in 2022 to support PeritoneX development, and was a finalist in multiple medtech innovation contests.

Early Detection & Risk Prediction

To prevent patients from "crashing" into kidney failure unknowingly, NKF invested in Klinrisk, an AI-driven health tech startup focusing on early identification of high-risk CKD. Announced in June 2023, Klinrisk builds on the idea that we now have effective drugs to slow kidney disease (like SGLT2 inhibitors), but they're underutilized because at-risk patients aren't identified early enough. Klinrisk's platform uses "highly accurate lab-based prediction models" – essentially advanced algorithms trained on large datasets – to flag which CKD patients are at highest risk of progression. It then provides decision support to clinicians, suggesting early interventions to prevent those patients from reaching dialysis or transplant.

NKF viewed Klinrisk as a way to bring "risk-based care" into nephrology, aligning with its mission to prevent kidney failure in the first place. NKF's own CEO is a kidney transplant recipient who acknowledged the "urgent need for early identification and intervention", endorsing that Klinrisk's AI could "revolutionize CKD care" by enabling proactive management.

🔵 Blue Team: An ounce of prevention is worth a pound of cure. If AI can stratify risk better than busy clinicians, precious time and treatment can be directed to those who need it most – potentially staving off kidney failure for thousands.

🔴 Red Team: AI in healthcare can struggle with adoption and trust. Klinrisk will need to integrate into clinical workflows (e.g. EHR systems) and convince nephrologists of its predictive accuracy. There's competition from major EHR vendors and insurers developing their own risk algorithms. Since NKF's investment, Klinrisk formed a partnership with ProKidney (a biotech working on cell therapy for CKD) in 2024, suggesting some traction – but until outcomes data show that AI-driven early care changes the trajectory for CKD patients, skepticism is warranted.

Immune Tolerance & Transplant Medicine

In early 2024, NKF made a strategic investment in ImmunoFree, a biotech startup aiming to eliminate the need for lifelong immunosuppressive drugs in organ transplant patients. ImmunoFree, co-founded by Garet Hil (the founder of the National Kidney Registry), is developing a stem cell transplant therapy that would induce immune tolerance to a transplanted kidney. The concept is that by giving the recipient a transplant of donor stem cells to "educate" the immune system, the patient's body would accept the new kidney without requiring anti-rejection medications. If successful, transplant recipients "lead longer, healthier lives free from the burdensome side effects" of immunosuppressants – greatly reducing risks like infection, cancer, and cardiovascular disease.

NKF's January 2024 announcement highlighted that solving the problems of chronic immunosuppression is "more critical than ever" – not least because immunocompromised patients faced extra dangers during COVID-19.

🔵 Blue Team: ImmunoFree strikes at a Holy Grail of transplant science: inducing tolerance. Achieving this would be a paradigm shift, improving graft longevity and patient quality of life dramatically. It aligns perfectly with NKF's mission to "accelerate innovation for the dignity of the patient experience." It could also expand transplants by enabling incompatible living donor pairs to go forward without rejection.

🔴 Red Team: Immune tolerance has been the subject of research for decades, with only limited success in small clinical trials. Bone marrow or stem cell transplants to induce tolerance can themselves be risky and complex. The timeline will require extensive clinical testing. For NKF, investing here is a moonshot – no financial return is guaranteed, and many similar efforts by academia and pharma have failed. One could argue this is exactly where philanthropic capital should go – into ideas with transformative potential that might scare off traditional VC due to long development cycles.

Performance and Impact to Date (as of Feb 2026)

In just under four years, the NKF Innovation Fund has assembled a portfolio that is impressive in scope, if not yet in realized returns. By the numbers: the fund has backed 10 companies to date, deploying an estimated few million dollars in total. It's still early days, but there are encouraging signs.

First Exit: MediGO → CareDx

One NKF portfolio company has already achieved a successful exit. MediGO, the organ logistics software startup NKF invested in late 2022, was acquired by CareDx (NASDAQ: CDNA) in July 2023. MediGO's platform for real-time organ tracking and transplant supply chain coordination was seen as strategically valuable; CareDx integrated it to enhance its digital health offerings for transplant centers. While financial terms weren't disclosed, the acquisition within ~7 months of NKF's investment suggests a positive outcome. Notably, CareDx's press release highlighted that "at the end of 2022, MediGO became a recipient of the NKF Innovation Fund investment", underlining NKF's role in nurturing the company.

🔵 Blue Team: Proof-of-concept that NKF can de-risk startups enough to facilitate scale-up or acquisition, translating innovation to impact.

🔴 Red Team: An acquisition, while good, is not the same as the product reaching patients at scale yet. It remains to be seen how fully CareDx's adoption of MediGO will "increase organ utilization and shorten wait times" as envisioned.

Follow-On Funding and Recognition

Several NKF-backed companies have attracted substantial follow-on funding or honors, indicating external validation:

These milestones suggest NKF's portfolio companies are succeeding in raising the next stage of capital or strategic partnerships needed to advance. That is a key metric for the fund's impact: it is bridging the gap for companies to reach larger investors. NKF seed-funded MediGO and 18 months later it was part of a public company – a trajectory that likely wouldn't have happened as quickly without that initial boost.

The red team would note that not all companies have announced such follow-on deals; some are still very much in R&D mode (e.g. ImmunoFree is just starting up, 34 Lives is still proving its tech). It's also possible that a few portfolio companies may struggle or pivot (as is normal in VC portfolios). Because of the short time frame, we haven't seen clinical trial readouts or FDA approvals yet from these ventures – those will be the true test of success.

Mission Metrics

Beyond financials, NKF measures success in mission terms: lives improved or saved, and innovations reaching patients. While it's too early for new therapies to have hit the market, we can track intermediate outcomes. By supporting preservation technologies (34 Lives, Northernmost, etc.), NKF is contributing to a trend of improving transplant numbers. 2023 saw a record 27,300+ kidney transplants in the US, and efforts like NKF's aim to push that higher. If Northernmost and BMI's devices enter service, they could drive down the current stat of ~90,000 patients on the kidney waitlist. Similarly, if Relavo's connector helps even a fraction of the ~550,000 US dialysis patients to safely adopt PD, that would be thousands of patients with better quality of life.

Internal Rate of Return

Since NKF's fund is not for-profit, IRR is not the primary metric – but for completeness, financial IRR currently would be low or negative (as expected in the first few years of a venture portfolio when investments are still maturing). The MediGO exit may have provided some return, but the majority of investments are unrealized. NKF is playing a long game – much like JDRF's T1D Fund took seven years to see major results (it's now one of the largest disease-focused funds, having made ~$15M of investments per year and helped catalyze $449M in follow-on capital to T1D programs). The Cystic Fibrosis Foundation waited over a decade for its Vertex deal to pay off massively. NKF's portfolio is on a similar trajectory where one big therapeutic success could yield both significant patient impact and potentially royalty or equity returns to sustain the fund.

The red team would caution against over-reliance on a "home run." NKF will need to manage its portfolio actively, possibly culling or doubling down as data emerges. There is also an implicit opportunity cost: dollars spent here are dollars not spent on more immediate patient services or traditional research grants. So far, NKF has balanced this by maintaining its other charitable programs separately, framing the Innovation Fund as an additional initiative to "accelerate the fight", not a replacement.

Comparisons to U.S. and European Peers

The NKF Innovation Fund is part of a broader trend of venture philanthropy in healthcare, but it also has unique aspects due to the nature of kidney disease.

United States Peer Funds

In the U.S., several patient-focused organizations have launched venture funds to drive cures. The JDRF T1D Fund (est. 2016) is one notable example: with $200M+ AUM and plans to double that, it invests globally in type-1 diabetes cure technologies. JDRF's fund has a narrower disease focus but a larger capital pool than NKF's, reflecting the more mature state of private funding for diabetes. Another peer is the Cystic Fibrosis Foundation (CFF), the pioneer of venture philanthropy in biomedical research. CFF invested early in CF drug development and famously earned a $3.3B payout by selling its royalty rights for the Vertex drugs it helped bring to market. That windfall now finances an annual research budget in the hundreds of millions.

Compared to these, NKF's fund is newer and smaller in scale, with no billion-dollar deals under its belt. However, NKF's approach is modeled after these successes – it explicitly notes that "other leading patient organizations" have used similar vehicles to spur breakthroughs, and "kidney patients deserve no less." The track record of JDRF and CFF shows that venture philanthropy can yield both medical and financial returns, but it requires patience and the right scientific opportunity.

A key difference: CF and T1D had some low-hanging fruit (modulator drugs for CF, immune therapies for T1D) ready for investment. In kidney disease, the red team might argue the challenges are more systemic (dialysis is a service, transplants depend on donor supply), meaning NKF's investments skew toward medtech and platform solutions rather than a single "magic bullet" drug. This could mean more modest exits (device company acquisitions in the tens of millions, not blockbuster drug royalties). But those modest wins can still dramatically improve care.

European Context

In Europe, dedicated venture funds for kidney innovation are not yet as established. Most kidney research funding comes from government grants (e.g. EU Horizon programs) or traditional charity grants via groups like Kidney Research UK. However, Kidney Research UK has recently started to emulate the venture philanthropy approach on a smaller scale – it set up a Development Advisory Board to provide seed investments and advice to kidney start-ups. For example, the charity co-funded a £610k seed round for Kidney Beam, an exercise and wellness app for kidney patients, in 2021.

European startups in the kidney space thus far often tap national innovation grants or generalist healthtech VCs. There isn't an EU analog of NKF's fund solely for renal disease. The UK Kidney Association and Dutch Kidney Foundation have supported innovation prizes but not full venture funds. NKF's fund is somewhat trailblazing even internationally – it stands out as a concerted, patient-led investment initiative in nephrology.

The red-team view might point out that Europe's relative lack of a venture fund could mean fewer ready partners or co-investors for NKF's companies abroad. On the other hand, NKF's leadership here could catalyze international collaborations – if a European startup has a great idea in kidney care, NKF's fund could potentially invest early where others wouldn't.

Thesis and Focus Differences

NKF's thesis is notably broad within kidney health – covering devices, diagnostics, software, biologics – whereas some peer funds have a narrower remit (JDRF only invests in therapies that can cure or treat T1D, mostly drugs and biologics). This broad approach is necessary because kidney disease spans many domains, but it also means NKF must develop expertise in evaluating diverse technologies. So far, NKF has done well assembling an advisory council with venture capitalists, clinicians, and industry experts. That helps balance the blue team enthusiasm for "saving patients" with red team diligence on business and science fundamentals.

One could argue NKF's fund complements its policy efforts: NKF lobbies for better reimbursement for home dialysis and transplant drugs, while funding companies that make home dialysis safer and potentially someday remove the need for immunosuppressants. This integrated strategy could give NKF an edge over a standalone investor – it can shape the market and adoption environment for its innovations. By contrast, pure VCs or even other charities may not have that synergy of advocacy + investment.

Conclusion: The Next 5–10 Years Will Be Telling

NKF's Innovation Fund has brought a venture mindset to a field that was long considered stagnant and "archaic" by experts. The blue team would applaud NKF for moving the needle and taking calculated risks that could yield huge rewards for patients. The red team would remind us that with high-risk investments, not all will succeed – careful portfolio management and sustained funding are critical. They'd also note that some systemic issues (like organ supply and dialysis economics) cannot be solved by startups alone; public policy and healthcare providers must be engaged (something NKF is indeed doing).

Despite being relatively young, the fund has already fostered a community of kidney innovators. It sends a clear message: the kidney space is open for business and ripe for disruption. This culture shift may be one of NKF's biggest contributions – one can already see more startups and investors paying attention to kidney disease than a decade ago.

Ultimately, the success of the NKF Innovation Fund will be measured in lives improved. If just a few of its investments lead to widely adopted products – be it a wearable dialysis machine, a big drop in PD infection rates, or more kidneys reaching patients – it could transform outcomes for the 37 million Americans with kidney disease. That would represent a victory for the blue team vision that justified this bold experiment in the first place, and it would validate NKF's premise that venture philanthropy can "accelerate the fight" against kidney disease in ways traditional funding models could not.

Disclaimer: The author is not a lawyer or financial adviser. The content presented here is for informational and educational purposes only and does not constitute investment advice, legal advice, or a recommendation to buy or sell any securities. Always conduct your own due diligence and consult qualified professionals before making investment decisions.