NHS England - Transformation Directorate

Remotely monitoring electrolyte imbalance in patients receiving haemodialysis for end-stage kidney disease

Digital consultations and virtual clinics enable many aspects of patient care to be managed remotely.

However, many patients must still attend a clinic to have tests taken before or after their remote review. This reduces a lot of the benefits of virtual reviews.

Blood tests to check kidney function are some of the most common tests to monitor long-term health conditions like:

  • chronic kidney disease
  • heart failure
  • diabetes


Many patients with long-term health conditions must frequently attend clinics for blood tests to measure their kidney function. This happens even when they are well and have no other need to see a healthcare professional.

These patients are also at high risk of poor outcomes if they get infected with COVID-19.

Enabling patients to test their kidney function at home would help them avoid attending clinics for tests, before or after a virtual clinic review.

Self-testing would also help patients monitor their healthcare around their life.

Using this type of technology to benefit patients and healthcare services aligns with the NHS Long Term Plan.


The Academic Health and Science Network (AHSN) for the North East and North Cumbria (NENC) wanted to help patients remotely measure their kidney function. They worked with the renal team in Middlesbrough to investigate this.

Working with patients receiving dialysis to develop this technology is helpful because kidney function changes before and after dialysis.


Alio.ai is a technology company based in the United States that worked with the AHSN NENC. Together, they developed an end-to-end remote technology platform designed for monitoring patients receiving haemodialysis. It uses wearable ‘SmartPatches’ to measure:

  • temperature
  • pulse oximetry
  • blood pressure and heart rate
  • haemocrit
  • haemoglobin

The renal team at Middlesbrough evaluated Alio for consented patients receiving haemodialysis.

As of March 2022, Alio is seeking Food and Drug Administration approval.


This collaborative work indicates this technology may be developed to provide a wearable device capable of remotely measuring patients’ kidney function.

Compared to standard blood tests taken at the start and end of dialysis sessions, Alio detected hyperkalaemia or hypokalaemia with 87% sensitivity and 89% specificity.


  • Alio SmartPatches are self-adhesive and are designed to be worn over arteriovenous fistulae or grafts.
  • A bedside Alio hub automatically and securely sends SmartPatch measurements to healthcare staff through a web-based portal. It does not require any apps or the need for patient interaction.
  • The system is General Data Protection Regulation (GDPR) compliant.


Alio needs minimal set-up from patients before it is used.

Signals measured by Alio SmartPatches can now be compared with blood test results taken as part of routine patient care.

After more development in the future, the technology may be able to:

  • detect hyperkalemia or hypokalemia earlier
  • monitor kidney function in real-time
  • send automatic notifications to healthcare staff when a patient is at risk

Alio is developing SmartPatches that can be worn over other blood vessels. This means that this technology can be used by more patients at home.


  • Alio’s SmartPatches can be used remotely by patients receiving haemodialysis treatment.
  • Further development of this technology should enable patients with other long-term health conditions to use Alio SmartPatches at home.

Key learning points

Collaboration between academic, clinical and commercial partners helped to ensure digital innovation has focused on meeting unmet clinical needs.

Remotely monitoring kidney function would mean patients do not need to attend clinics for tests when they are otherwise well and do not need to see a healthcare professional.

Key contact

Dr. Jonathan Murray, Consultant Nephrologist, South Tees Hospitals NHS Foundation Trust


David Kuraguntla, Chief Executive Officer, Alio