K Number
K042045
Device Name
NXSTAGE PUREFLOW-B SOLUTION
Date Cleared
2004-08-27

(28 days)

Product Code
Regulation Number
876.5820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
NxStage PureFlow-B Solution is indicated for use with renal replacement therapy systems that utilize sterile premixed dialysate.
Device Description
The NxStage PureFlow Solution with bicarbonate (NxStage PureFlow-B Solution) is a non-pyrogenic dialysis solution provided in single use flexible bags. The PureFlow-B Solution is intended for use with renal replacement therapy systems that utilize sterile premixed dialysate.
More Information

Not Found

No
The summary describes a dialysis solution and its intended use with renal replacement therapy systems. There is no mention of AI, ML, or any computational processing that would suggest the use of such technologies.

Yes
The device is a dialysis solution used in renal replacement therapy systems, which is a medical treatment designed to treat a disease or condition (kidney failure).

No
The device description states it is a "dialysis solution provided in single use flexible bags," which is a treatment solution, not a device used for diagnosis.

No

The device description clearly states it is a "non-pyrogenic dialysis solution provided in single use flexible bags," indicating a physical product, not software.

Based on the provided information, the NxStage PureFlow-B Solution is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for "renal replacement therapy systems that utilize sterile premixed dialysate." This describes a therapeutic use, not a diagnostic one.
  • Device Description: The description focuses on the composition and packaging of a dialysis solution, which is a substance used in treatment, not for testing samples outside the body to diagnose or monitor a condition.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information for diagnosis, monitoring, or screening
    • Using reagents or assays to detect specific substances

The device is a component used in a medical treatment (renal replacement therapy), not a tool for performing diagnostic tests.

N/A

Intended Use / Indications for Use

NxStage PureFlow-B Solution is indicated for use with renal replacement therapy systems that utilize sterile premixed dialysate.

Product codes

78 KPO

Device Description

The NxStage PureFlow Solution with bicarbonate (NxStage PureFlow-B Solution) is a non-pyrogenic dialysis solution provided in single use flexible bags. The PureFlow-B Solution is intended for use with renal replacement therapy systems that utilize sterile premixed dialysate.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Not Found

Key Metrics

Not Found

Predicate Device(s)

K033386

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5820 Hemodialysis system and accessories.

(a)
Identification. A hemodialysis system and accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions and that consists of an extracorporeal blood system, a conventional dialyzer, a dialysate delivery system, and accessories. Blood from a patient flows through the tubing of the extracorporeal blood system and accessories to the blood compartment of the dialyzer, then returns through further tubing of the extracorporeal blood system to the patient. The dialyzer has two compartments that are separated by a semipermeable membrane. While the blood is in the blood compartment, undesirable substances in the blood pass through the semipermeable membrane into the dialysate in the dialysate compartment. The dialysate delivery system controls and monitors the dialysate circulating through the dialysate compartment of the dialyzer.(1) The extracorporeal blood system and accessories consists of tubing, pumps, pressure monitors, air foam or bubble detectors, and alarms to keep blood moving safely from the blood access device and accessories for hemodialysis (§ 876.5540) to the blood compartment of the dialyzer and back to the patient.
(2) The conventional dialyzer allows a transfer of water and solutes between the blood and the dialysate through the semipermeable membrane. The semipermeable membrane of the conventional dialyzer has a sufficiently low permeability to water that an ultrafiltration controller is not required to prevent excessive loss of water from the patient's blood. This conventional dialyzer does not include hemodialyzers with the disposable inserts (Kiil type) (§ 876.5830) or dialyzers of high permeability (§ 876.5860).
(3) The dialysate delivery system consists of mechanisms that monitor and control the temperature, conductivity, flow rate, and pressure of the dialysate and circulates dialysate through the dialysate compartment of the dialyzer. The dialysate delivery system includes the dialysate concentrate for hemodialysis (liquid or powder) and alarms to indicate abnormal dialysate conditions. This dialysate delivery system does not include the sorbent regenerated dialysate delivery system for hemodialysis (§ 876.5600), the dialysate delivery system of the peritoneal dialysis system and accessories (§ 876.5630), or the controlled dialysate delivery system of the high permeability hemodialysis system § 876.5860).
(4) Remote accessories to the hemodialysis system include the unpowered dialysis chair without a scale, the powered dialysis chair without a scale, the dialyzer holder set, dialysis tie gun and ties, and hemodialysis start/stop tray.
(b)
Classification. (1) Class II (performance standards) for hemodialysis systems and all accessories directly associated with the extracorporeal blood system and the dialysate delivery system.(2) Class I for other accessories of the hemodialysis system remote from the extracorporeal blood system and the dialysate delivery system, such as the unpowered dialysis chair, hemodialysis start/stop tray, dialyzer holder set, and dialysis tie gun and ties. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

Ko42045 R275/ of.

AUG 27 2004

Section 7 510(K) Summary of Safety Effectiveness

This 510(k) summary of safety and effectiveness information is being submitted in accordance with the requirements of the Safe Medical Device Act (SMDA) of 1990. The contents of this 510(k) summary have been provided in conformance with 21 CFR 807.92.

Date:July 29, 2004
Common/Usual Name:Premixed Dialysate for Hemodialysis
Trade/Proprietary Name:NxStage PureFlow-B Solution
Classification Name:Hemodialysis systems and accessories
(21 CFR 876.5820)
Device Classification:Class II
Product Code:78 KPO - Dialysate Concentrate for Hemodialysis
(Liquid or Powder)
Device Panel:Gastroenterology-Urology (GU)/Gastro-Renal
(GRDB)
510(k) Sponsor &
Owner/Operator:NxStage Medical, Inc
439 South Union St, Suite 501
Lawrence, MA 01843
Owner/Operator No. 9045797
Establishment Registration #3003464075
Contact Person:Norma LeMay
Manager, Regulatory Affairs

Device Description:

The NxStage PureFlow Solution with bicarbonate (NxStage PureFlow-B Solution) is a non-pyrogenic dialysis solution provided in single use flexible bags. The PureFlow-B Solution is intended for use with renal replacement therapy systems that utilize sterile premixed dialysate.

Special 510(k) Premarket Notification Device Modification NxStage Medical, Inc. NxStage PureFlow-B Solution

1

Substantial Equivalence:

This submission is a Special 510(k) Device Modification as described in FDA's guidance document entitled "The New 510(k) Paradigm - Alternate Approaches to Demonstrating Substantial Equivalence in Pre-Market Notifications." In support of this 510(k), NxStage has provided certification of compliance to 21 CFR 820.30 Design Control requirements. Design validation testing has been performed to ensure that the modified device meets design specifications. The modified NxStage PureFlow Solution has been compared to the baseline as cleared in K033386 and found to be substantially equivalent.

Conclusion:

Based on the device indications for use, comparison of descriptive and technological characteristics, and design control certification, the modified NxStage PureFlow Solution has been shown to meet the minimum requirements that are considered acceptable for its intended use.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle or bird-like figure with three curved lines forming its body and wings. The logo is surrounded by text that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement. The text is in all caps and appears to be in a sans-serif font.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 27 2004

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

Re: K042045

KU42045
Trade/Device Name: NxStage PureFlow Solution with Bicarbonate (PureFlow-B) Regulation Number: 21 CFR §876.5820 Regulation Name: Hemodialysis system and accessories Regulatory Class: II Product Code: 78 KPO Dated: July 29, 2004 Received: July 30, 2004

Dear Ms. LeMay:

We have reviewed your Section 510(k) premarket notification of intent to market the device w o forrowed your and have determined the device is substantially equivalent (for the indications forchenood above and harsure) to legally marketed predicate devices marketed in interstate for associated in the May 28, 1976, the enactment date of the Medical Device Amendments, or to conimores that have been reclassified in accordance with the provisions of the Federal Food, Drug, de Hoos that have been 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 r ou may, dicrerere, mains of the Act include requirements for annual registration, listing of general controls provision 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 your device is easonivals. 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 round in 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 that I Drines interves and regulations administered by other Federal agencies. You must or any Federal statuter and and ing, 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.

3

This letter will allow you to begin marketing your device as described in your Section 510(k)
The same and the same of the first of Substantial equivalence of your device to This letter will allow you to begin marketing your actives of your device of your device to a legally
premarket notification The FDA indines of substantial equivalence of y premarket notification - The FDA linding of substantial or 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
s and the many of the many of the fellouing numbers, hased on the regulat If you desire specific advice for your device on our laboling toge.
contact the Office of Compliance at one of the following numbers, based on the regulation in number at the top of the letter:

8xx. Ixxx(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 advectising of your device, please contact the Additionally, for questions on the production and the regulation entitled, "Maintanding
Office of Compliance at (301) 594-4639 - Association may obtain - Other oceecal Office of Compliance at (301) 394-4057. Also, posts and obtain. Other general by reference to premarket notification (210, 10, 10, 10, 10, 2011, 10:11 the Division of Small
information on your responsibilities under the Act may be obtained from the Div information on your responsibilities and its its tall-free number (800) -638-2041 or
Manufacturers, International and Consumer Assistance at its toll-free maman huml Manufacturers, International and Collisumer Assistantoo at le 18.1.2017
(301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

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

4

Indications for Use

510(k) Number (if known):

NxStage PureFlow-B Solution Device Name:

Indications for Use:

NxStage PureFlow-B Solution is indicated for use with renal replacement therapy systems that utilize sterile premixed dialysate.

Prescription Use _____________________________________________________________________________________________________________________________________________________________ × (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use_ (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Daniel R. Larson

(Division Sign-Off) Division of Reproductive, A and Radiological Devices 51()(k) Number _

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