K Number
K080919
Device Name
NXSTAGE PUREFLOW SL
Date Cleared
2008-10-15

(197 days)

Product Code
Regulation Number
876.5820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The NxStage PureFlow SL module is an optional accessory to the NxStage System One that prepares dialysate for use during hemodialysis, as prescribed by the physician.
Device Description
The NxStage PFSL module is an optional accessory to the NxStage System One that is used to treat water for hemodialysis and proportion it with dialysate concentrate to produce dialysate per ANSI/AAMI RD52:2004 and ANSI/AAMI RD62: 2006. The PFSL module consists of the Control Unit (CU), the water Pre-Treatment Unit, the Purification Pack (PAK), and the Dialysate Sack (SAK) with Dialysate Concentrate.
More Information

Not Found

No
The document describes a system for preparing dialysate for hemodialysis and does not mention any AI or ML components or functionalities.

No
The device prepares dialysate for hemodialysis, which is a treatment, but the device itself is described as an accessory that treats water and proportions it with concentrate to produce the dialysate, not directly administering or performing the therapy on a patient. It is a component in the therapeutic process, but not the therapeutic device itself.

No

The device description indicates that the NxStage PureFlow SL module prepares dialysate for hemodialysis by treating water and proportioning it with concentrate. Its function is to produce dialysate, not to diagnose a medical condition.

No

The device description explicitly lists multiple hardware components (Control Unit, water Pre-Treatment Unit, Purification Pack, Dialysate Sack) that are part of the device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to prepare dialysate for use during hemodialysis. This is a process that supports a medical treatment (hemodialysis) and is not used to diagnose a condition or analyze a sample from the human body in vitro (outside the body).
  • Device Description: The description details how the device treats water and mixes it with concentrate to produce dialysate. This is a manufacturing or preparation process, not a diagnostic test.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples, detecting biomarkers, or providing diagnostic information.

IVD devices are typically used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. This device's function falls outside of that scope.

N/A

Intended Use / Indications for Use

The NxStage PFSL module is an optional accessory to the NxStage System One that prepares dialysate for use during hemodialysis, as prescribed by the physician.

Product codes (comma separated list FDA assigned to the subject device)

78 FKR, FKR

Device Description

The NxStage PFSL module is an optional accessory to the NxStage System One that is used to treat water for hemodialysis and proportion it with dialysate concentrate to produce dialysate per ANSI/AAMI RD52:2004 and ANSI/AAMI RD62: 2006. The PFSL module consists of the Control Unit (CU), the water Pre-Treatment Unit, the Purification Pack (PAK), and the Dialysate Sack (SAK) with Dialysate Concentrate.

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Performance, verification and validation testing was conducted to characterize performance of the proposed PFSL to provide a basis of comparison to the predicate device as all features are not identical. Results of this testing have documented that the proposed PFSL module is substantially equivalent to the predicate device and is suitable for the labeled indications for use.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K060296

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as it appears in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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.

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K0806919
PAGE 1 OF 2

NxStage Medical, Inc. NxStage PureFlow SL (PFSL) 510(k) Device Modification

This 510(k) Summary is being submitted in accordance with the requirements of the Safe Medical Device Act (SMDA) of 1990. The content contained in this 510(k) summary has been provided in conformance with 21 CFR §807.92

A. Submitter's Information:

Name:NxStage Medical Inc.
Address:439 South Union Street, 5th Floor
Lawrence, MA 01843
FDA Establishment
Owner/Operator Number:9045797
Contact Person:Michael Doyle
Manager, Regulatory Affairs
Phone:
Fax:(978) 687-4746
(978) 687-4750
Manufacturing Site:Entrada Group/NxStage
Carretera Fresnillo A Plateros, KM2
Fresnillo, Zacatecas 99059
Mexico
FDA Establishment
Registration Number:3006546166
Manufacturing/Sterilization
Site:Steris Isomedix, Inc.
1000 S. Sarah Place
Ontario, CA 91761
B. Device Name:
Trade/Proprietary Name:NxStage PureFlow SL
Common/Usual Name:Subsystem, proportioning
Classification Name:Hemodialysis Systems & Accessories
Regulation Number:876.5820
Product Code:78 FKR
Device Classification:Class II
Device Panel:Gastroenterology/Urology

Special 510(k)

1

NxStage Medical, Inc. NxStage PureFlow SL (PFSL) Special 510(k) Device Modification

  • C. Substantial Equivalence/Predicate Devices:
    This submission is a Special 510(k) Device Modification as described in the FDA's Guidance document entitled, #The New 510(k) Paradigm - Alternate Approaches to Demonstrating Substantial Equivalence in Premarket Notifications." In support of this Special 510(k), NxStage has provided certification of compliance to 21 CFR §820.30 Design Control Requirements. Design validation testing was performed to ensure that the NxStage PureFlow SL (PFSL) module with modifications meets design specifications. The NxStage PFSL module with modifications has been compared to the legally marketed predicated device as cleared through K060296 (March 31, 2006) and was found to be substantially equivalent.

D. Device Description/Indications for Use:

The NxStage PFSL module is an optional accessory to the NxStage System One that is used to treat water for hemodialysis and proportion it with dialysate concentrate to produce dialysate per ANSI/AAMI RD52:2004 and ANSI/AAMI RD62: 2006. The PFSL module consists of the Control Unit (CU), the water Pre-Treatment Unit, the Purification Pack (PAK), and the Dialysate Sack (SAK) with Dialysate Concentrate.

Indications for use:

The NxStage PFSL module is an optional accessory to the NxStage System One that prepares dialysate for use during hemodialysis, as prescribed by the physician.

E. Technological Characteristics:

The proposed device has the same technological characteristics and is similar in design and configuration as compared to the predicate device. The proposed device is designed with similar components and features also used in the predicate device.

F. Summary of Non-Clinical Test/Performance Testing - Bench:

NxStage Medical, Inc. 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 indications for use. Performance, verification and validation testing was conducted to characterize performance of the proposed PFSL to provide a basis of comparison to the predicate device as all features are not identical. Results of this testing have documented that the proposed PFSL module is substantially equivalent to the predicate device and is suitable for the labeled indications for use.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

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 eagle with three lines representing its wings. The eagle is enclosed within a circular border, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" surrounding it.

OCT 15 2008

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Michael J. Doyle Manager, Regulatory Affairs NxStage Medical, Inc. 439 South Union Street, 5th Floor LAWRENCE MA 01843

K080919 Re:

Trade/Device Name: NxStage PureFlow SL Regulation Number: 21 CFR §876.5820 Regulation Name: Hemodialysis system and accessories Regulatory Class: II Product Code: FKR Dated: August 12, 2008 Received: August 13, 2008

Dear Mr. Doyle:

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 such 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.

3

Page 2

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.

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 this letter:

21 CFR 876.xxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxx(Obstetrics/Gynecology)240-276-0115
21 CFR 894.xxx(Radiology)240-276-0120
Other240-276-0100

Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometrics' (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely vours.

Jorgu M. Whang

Joyce M. Whang, Ph.D. Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

510(k) Number (if known):K08919
Device Name:NxStage PureFlow SL
Indications for Use:The NxStage PureFlow SL module is an optional accessory to
the NxStage System One that prepares dialysate for use during
hemodialysis, as prescribed by the physician.

Prescription Use __ X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH(Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Reproductive, Abdominal,
and Radiological Devices

510(k) Number K080919

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Special 510(k)

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