K Number
K032356
Date Cleared
2003-10-28

(90 days)

Product Code
Regulation Number
876.5860
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The NxStage System One is indicated for treatment of renal failure or fluid overload using hemofiltration, hemodialysis, and/or ultrafiltration. All treatments must be administered by a health care provider, under physician's prescription.

Device Description

The NxStage System One consists of the NxStage Cycler and the NxStage Cartridge Extracorporeal Blood and Fluid Circuit. The NxStage Cycler is an electro-mechanical device that interfaces with the NxStage Cartridge. The NxStage Cartridge is a single-use extracorporeal blood circuit and fluid management device that mounts integrally within the NxStage Cycler. The NxStage Cartridge Express is a single-use extracorporeal blood circuit and fluid management device with a pre-attached high flux (permeability) hollowfiber filter.

AI/ML Overview

The provided text describes the NxStage System One with Cartridge Express, a device intended for the treatment of renal failure or fluid overload using hemofiltration, hemodialysis, and/or ultrafiltration. However, the document does not contain the detailed information necessary to complete all sections of the request, particularly regarding specific acceptance criteria, a dedicated study proving performance against those criteria, sample sizes for test and training sets, expert qualifications, or details about comparative effectiveness studies.

Here's a summary of the information that can be extracted and a note on what is missing:


1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly state specific numerical acceptance criteria or detail the reported device performance against such criteria. It generally states that "Performance testing was conducted to characterize the performance of the NxStage Cartridge Express during hemodialysis to provide a basis of comparison to the predicate devices. Results of the performance testing have documented that the NxStage Cartridge Express is substantially equivalent to the predicate devices and is suitable for the labeled indication for use."

Therefore, a table cannot be constructed with specific criteria or performance metrics from the provided text.


2. Sample Size Used for the Test Set and Data Provenance

The document mentions "Performance testing" but does not specify the sample size used for any test set or the data provenance (e.g., country of origin, retrospective or prospective nature).


3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications

This information is not provided in the document.


4. Adjudication Method for the Test Set

This information is not provided in the document.


5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size

The document does not describe a Multi-Reader Multi-Case (MRMC) comparative effectiveness study, nor does it quantify any effect size of human readers improving with or without AI assistance. The device in question is a medical device (dialyzer system), not an AI-assisted diagnostic tool.


6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done

The device is an electro-mechanical system for treating renal conditions, not an algorithm. Therefore, the concept of "standalone (algorithm only)" performance is not applicable to this device described in the document.


7. The Type of Ground Truth Used

The document indicates that performance testing was conducted to demonstrate "substantial equivalence to the predicate devices" and "suitability for the labeled indication for use." This implies that the "ground truth" or reference for evaluating the device's performance was based on the performance characteristics of its predicate devices, rather than an independent gold standard like pathology or long-term outcomes data, as would be typical for a diagnostic device.


8. The Sample Size for the Training Set

The document does not mention a training set, as the device is not an AI/machine learning model that undergoes a training phase.


9. How the Ground Truth for the Training Set Was Established

As there is no mention of a training set, this information is not applicable or provided.


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OCT 2 8 2003

NxStage Medical, Inc. NxStage System One 510(k) Premarket Notification

K032356

Section VIII: 510(k) Summary

This 510(k) Summary of Safety and Effectiveness is being submitted in accordance with the requirements of SMDA 1990.

A. Submitter's Information:

Name:NxStage Medical, Inc.
Address:439 South Union Street, Suite 501Lawrence, MA 01843
Phone:(978) 687-4700
Fax:(978) 687-4800
Contact Person:Norma LeMaySr. Regulatory Specialist
Date of Preparation:July 29, 2003

B. Device Name:

Trade Name:NxStage System One with Cartridge Express
Common/Usual Name:Dialyzer with High Permeability HemodialysisSystem
Classification Name:Dialyzer, High Permeability with or without SealedDialysate System (21 CFR 875.5860, ProductCode 78 KDI)

C. Substantial Equivalence/Predicate Devices:

The NxStage Cartridge Express is substantially equivalent to the following legally marketed predicate devices previously cleared by FDA:

  • NxStage Cartridge Express (K014152, cleared 12/10/02) ●
  • Gambro Prisma CFM System Disposable Tubing Set (K946279, cleared . 02/10/97)

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NxStage Medical, Inc. NxStage System One 510(k) Premarket Notification

Section VIII: 510(k) Summary

KOZZ356

D. Device Description/Intended Use:

The NxStage System One consists of the NxStage Cycler and the NxStage Cartridge Extracorporeal Blood and Fluid Circuit.

The NxStage Cycler is an electro-mechanical device that interfaces with the NxStage Cartridge. The NxStage Cartridge is a single-use extracorporeal blood circuit and fluid management device that mounts integrally within the NxStage Cycler. The NxStage Cartridge Express is a single-use extracorporeal blood circuit and fluid management device with a pre-attached high flux (permeability) hollowfiber filter.

The System (and all components) is intended for treatment of renal failure or fluid overload using hemofiltration, hemodialysis, and/or ultrafiltration in both acute and chronic environments, as prescribed by the treating physician.

Indications for use:

The NxStage System One is indicated for treatment of renal failure or fluid overload using hemofiltration, hemodialysis, and/or ultrafiltration. All treatments must be administered by a health care provider, under physician's prescription.

E. Technological Characteristics:

The NxStage Cartridge Express has the same technological characteristics and is similar in design and configuration as compared to the predicate devices. There are no material changes to the NxStage Cartridge Express as described and cleared through K014152, as a result of this 510(k) submission. The only difference between the proposed Cartridge Express as compared to the predicate (K014152) is the expansion in intended use to include hemodialysis.

F. Summary of Non-Clinical Test/Performance Testing

NxStage believes that the information and data provided in this submission clearly describes the proposed device and demonstrates that the device is adequately designed for the labeled indication for use. Performance testing was conducted to characterize the performance of the NxStage Cartridge Express during hemodialysis to provide a basis of comparison to the predicate devices. Results of the performance testing have documented that the NxStage Cartridge Express is substantially equivalent to the predicate devices and is suitable for the labeled indication for use.

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Image /page/2/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle head in profile, facing left, with three curved lines above it, representing the department's mission. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the eagle, framing the image.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 2 8 2003

Ms. Norma LeMay Senior Regulatory Specialist NxStage Medical, Inc. 439 South Union Street 5th Floor LAWRENCE MA 01843

Re: K032356

Trade/Device Name: NxStage System One With Cartridge Express Regulation Number: 21 CFR §876.5860 Regulation Name: High permeability hemodialysis system Regulatory Class: II Product Code: 78 KDI Dated: July 29, 2003 Received: July 30, 2003

Dear Ms. LeMay:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

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This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of the letter:

8xx.1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely vours.

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

Page 2

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INDICATION FOR USE STATEMENT

Page 1 of 1

510(k) Number (if known):

K032356

Device Name:

NxStage System One with Cartridge Express

Indication for Use:

The NxStage System One is indicated for treatment of renal failure or fluid overload using hemofiltration, hemodialysis, and/or ultrafiltration. All treatments must be administered by a health care provider, under physician's prescription.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use_

David R. Ingram

(Division Sign-Off)

Division of Reproductive, Abdominal, and Radiological De 510(k) Number

06.2

§ 876.5860 High permeability hemodialysis system.

(a)
Identification. A high permeability hemodialysis system is a device intended for use as an artificial kidney system for the treatment of patients with renal failure, fluid overload, or toxemic conditions by performing such therapies as hemodialysis, hemofiltration, hemoconcentration, and hemodiafiltration. Using a hemodialyzer with a semipermeable membrane that is more permeable to water than the semipermeable membrane of the conventional hemodialysis system (§ 876.5820), the high permeability hemodialysis system removes toxins or excess fluid from the patient's blood using the principles of convection (via a high ultrafiltration rate) and/or diffusion (via a concentration gradient in dialysate). During treatment, blood is circulated from the patient through the hemodialyzer's blood compartment, while the dialysate solution flows countercurrent through the dialysate compartment. In this process, toxins and/or fluid are transferred across the membrane from the blood to the dialysate compartment. The hemodialysis delivery machine controls and monitors the parameters related to this processing, including the rate at which blood and dialysate are pumped through the system, and the rate at which fluid is removed from the patient. The high permeability hemodialysis system consists of the following devices:(1) The hemodialyzer consists of a semipermeable membrane with an in vitro ultrafiltration coefficient (K
uf ) greater than 8 milliliters per hour per conventional millimeter of mercury, as measured with bovine or expired human blood, and is used with either an automated ultrafiltration controller or anther method of ultrafiltration control to prevent fluid imbalance.(2) The hemodialysis delivery machine is similar to the extracorporeal blood system and dialysate delivery system of the hemodialysis system and accessories (§ 876.5820), with the addition of an ultrafiltration controller and mechanisms that monitor and/or control such parameters as fluid balance, dialysate composition, and patient treatment parameters (e.g., blood pressure, hematocrit, urea, etc.).
(3) The high permeability hemodialysis system accessories include, but are not limited to, tubing lines and various treatment related monitors (e.g., dialysate pH, blood pressure, hematocrit, and blood recirculation monitors).
(b)
Classification. Class II. The special controls for this device are FDA's:(1) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Device—Part I: Evaluation and Testing,’ ”
(2) “Guidance for the Content of 510(k)s for Conventional and High Permeability Hemodialyzers,”
(3) “Guidance for Industry and CDRH Reviewers on the Content of Premarket Notifications for Hemodialysis Delivery Systems,”
(4) “Guidance for the Content of Premarket Notifications for Water Purification Components and Systems for Hemodialysis,” and
(5) “Guidance for Hemodialyzer Reuse Labeling.”