(272 days)
The Isopure Corp Dry Acid Dissolution System is designed to mix dry acid concentrates with purified water to produce an acid concentrate solution for hemodialysis for use in 3- Stream (acid concentrate, bicarbonate concentrate, and water) hemodialysis machines.
The Isopure Dry Acid Dissolution System consists mainly of a Mixing Tank, a Distribution and Mixing Pump, a Hopper (with or without an automated opening mechanism), a Venturi inductor, and accompanying hydraulics and control circuits and sensors. The users will enter the dry acid powder mix into the Hopper either manually or by means of the automated bag opening mechanism. The contents of the Hopper will be drawn into the Mixing Tank by means of the Venturi inductor and the Distribution and Mixing Pump. Once all bags have been entered and the solution thoroughly mixed, the reading of the hydrostatic pressure inside the Tank will be converted into a specific gravity value. This in turn will be used to verify that the proper solution has been prepared against a pre-loaded table of values provided by the powder manufacturer. If the solution passes this verification, the system will allow transferring of the solution to the corresponding storage tank in the facility. The tanks will be identified by the use of quick connectors with RFID to prevent the transfer hose from being connected to the wrong tank.
The provided text describes the Isopure Dry Acid Dissolution System, a medical device for preparing hemodialysis solutions. However, it does not describe an AI/ML-based medical device. Therefore, it does not contain the information required to answer the prompt regarding acceptance criteria and a study proving the device meets those criteria for an AI/ML device.
The document is a 510(k) summary for a traditional medical device. It lists non-clinical performance data and explicitly states: "No clinical performance testing was required for determination of substantial equivalence of this type and class of device."
Therefore, I cannot provide the requested information, particularly points 1-9, as they pertain to the evaluation of an AI/ML medical device, which is not what this document describes.
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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.
January 22, 2020
Isopure, Corp. Kevin Gillespie President & CEO 11851 Plantside Drive Louisville, KY 40299
Re: K191093
Trade/Device Name: Isopure Dry Acid Dissolution System Regulation Number: 21 CFR 876.5820 Regulation Name: Hemodialysis System And Accessories Regulatory Class: II Product Code: KPO Dated: December 20, 2019 Received: December 23, 2019
Dear Kevin Gillespie:
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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.
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.
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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); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.
Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.
For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely.
Carolyn Y. Neuland, Ph.D. Assistant Director DHT3A: Division of Renal, Gastrointestinal, Obesity and Transplant Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health
Enclosure
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FORM 3881
DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Indications for Use
Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2020 See PRA Statement below.
510(k) Number (if known)
Device Name Isopure Dry Acid Dissolution System
Indications for Use (Describe)
The Isopure Corp Dry Acid Dissolution System is designed to mix dry acid concentrates with purified water to produce an acid concentrate solution for hemodialysis for use in 3- Stream (acid concentrate, bicarbonate concentrate, and water) hemodialysis machines.
Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)
CONTINUE ON A SEPARATE PAGE IF NEEDED.
This section applies only to requirements of the Paperwork Reduction Act of 1995
*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW."
The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:
Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov
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FORM FDA 3881 (7/17)
Page 1 of 1
PSC Publishing Services (301) 443-6740 EF
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Image /page/3/Picture/0 description: The image shows the word "ISOPURE" in large, blue, sans-serif font. Below the text is a graphic of splashing water, also in shades of blue. The water graphic appears to be a stylized representation of water droplets and waves, giving the impression of purity and freshness.
11851 Plantside Drive Louisville, Kentucky 4 502-267-7873 · 800-280-PURE (7873) · Fax: 502-297-5066 www.isopure.com
K191093 Page 1 of 7
I. 510(k) SUMMARY
This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of SMDA 1990 and 21 CFR §807.92.
| Submitter's Name: | Isopure, Corp. |
|---|---|
| 11851 Plantside Drive | |
| Louisville, KY 40299 | |
| (502) 267-7873 x6672 |
Kevin Gillespie Contact person:
Date of Summary: January 22, 2020
| Establishment | |
|---|---|
| Registration Number: | 3003768032 |
| Device Name: | Isopure Dry Acid Dissolution System |
| Common Name: | Hemodialysis System and Accessories |
| Product Code: | KPO |
| Device Class: | II |
| Classification Name: | Hemodialysis System and Accessories |
| Regulation Number: | 21 CFR 876.5820 |
Predicate Device for Fresenius Medical Care Dry Acid Dissolution Unit, K131611 Substantial Equivalence:
The Isopure Dry Acid Dissolution System consists mainly of a Device Description: Mixing Tank, a Distribution and Mixing Pump, a Hopper (with or without an automated opening mechanism), a Venturi inductor, and accompanying hydraulics and control circuits and sensors. The users will enter the dry acid powder mix into the Hopper either manually or by means of the automated bag opening mechanism. The contents of the Hopper will be drawn into the Mixing Tank by means of the Venturi inductor and the Distribution and Mixing Pump. Once all bags have been entered and the solution thoroughly mixed, the reading of the hydrostatic pressure inside the Tank will be converted into a specific gravity value. This in turn will be used to verify that the proper solution has been prepared against a pre-loaded table of values provided by the powder manufacturer. If the solution passes this verification, the system will allow transferring of the solution
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Image /page/4/Picture/0 description: The image shows the word "ISOPURE" in large, blue, sans-serif font above a blue and white image of water splashing. Below the water image is the address "11851 Plantside Drive Louisville, Kentucky 40299" in a smaller, blue, sans-serif font. The address is likely the location of the company associated with the "ISOPURE" brand.
502-267-7873 ● 800-280-PURE (7873) ● Fax: 502-297-5066 www.isopure.com
K191093 Page 2 of 7
to the corresponding storage tank in the facility. The tanks will be identified by the use of quick connectors with RFID to prevent the transfer hose from being connected to the wrong tank.
Intended Use: The Isopure Dry Acid Dissolution System is designed to mix dry acid concentrates with purified water to produce an acid concentrate solution for hemodialysis for use in 3- Stream (acid concentrate, bicarbonate concentrate, and water) hemodialysis machines.
| Technological Comparisonto Predicate DeviceSpecifications | Isopure Dry Acid DissolutionSystem | FMC Granuflo (Dry AcidDissolution System) |
|---|---|---|
| Classification Name AndProduct Code | (K131611) | |
| Intended Use | The Isopure Dry AcidDissolution System is designedto mix dry acid concentrateswith purified water to producean acid concentrate solutionfor hemodialysis for use in 3-Stream (acid concentrate,bicarbonate concentrate, andwater) hemodialysis machines. | The Fresenius Medical CareDry Acid Dissolution Unitmixes Fresenius MedicalCare-distributed dry acidconcentrate products withhemodialysis quality water.The resulting liquid acidconcentrates are intendedfor use in three-streamhemodialysis machinescalibrated for acid andbicarbonate concentrates. |
| Water Requirements:Water Quality | AAMI Quality (RD 62) /ISO 23500-3: 2019 | AAMI Quality (RD 62) |
| Standards | ISO 23500 (-1, -4): 2019(NOTE: ISO 23500- 4 replaces ISO 13958:2014)EN 61326-1:2013 &IEC60601-1-2:2014 (4thEdition)- Emissions(EN55011:2009+A1:2010,IEC 61000-3-2:2014, IEC61000-3-3:2013) | ISO 23500: 2014ISO 13958: 2014EN 61326-1:2013 &IEC60601-1 EmissionsIEC60601-1 Immunity |
| Technological Comparisonto Predicate DeviceSpecifications | Isopure Dry Acid DissolutionSystem | FMC Granuflo (Dry AcidDissolution System) |
| EN 61326-1:2013 &IEC60601-1-2:2014 (4thEdition)- Immunity (IEC6100-4-2:2008, IEC61000-4-3:2010,IEC61000-4-4:2010, IEC61000-4-4:2012, IEC61000-4-5:2014, IEC61000-4-6:2013,IEC61000-4-8:2009, IEC61000-4-11:2010) | ||
| Batch size | 99 gallons and 132 gallons | 99 gallons and 132 gallons |
| Disinfection | Peracetic Acid (45 minutes) | Bleach (30 minutes) |
| Mix Preparation Method | Initial Fill Bag Opening Concurrent Mix Final Fill Recirculation and Mix QA Transfer | Initial Fill Add Granules Mix / De-aeration Final Fill Homogenize QA Transfer |
| Data Entry | Scan or manual entry of barcodeinformation of boxes and bagsinto the system | Manual record keeping ofinformation of boxes and bags. |
| Mixing method | High Flow Recirculation | High Flow recirculation /Mechanical propeller mixer |
| Powder entry method | Manual entry of powderdirectly into the Hopper Automated bag openerto transfer powder intoHopper. (accessory) | Manual entry of powderdirectly into the tank |
| Main Materials in Contact withFluids | HDPE, EPDM, 316SS, PP, PE | HDPE, EPDM, 316SS, PP, PVC |
| Batch Verification | Measure Hydrostatic Pressure toindirectly calculate SpecificGravity (SG). Use of Powdermanufacturer pass / fail SG data | User to manually measure SGand use Powder manufacturerpass / fail SG data to manuallyverify the solution |
| Technological Comparisonto Predicate DeviceSpecifications | Isopure Dry Acid DissolutionSystem | FMC Granuflo (Dry AcidDissolution System) |
| to automatically verify thesolution | ||
| Transfer Method | RFID connectors on transfer hoseand holding tanks to verify thatsolution is transferred to theproper tank. Decision based onuser predefined data. | Manual verification that thesolution is transferred to theproper tank. |
| Record Keeping | System to maintain electronicrecords and print reports as paperback up | Paper Reports manually filledby users. |
Substantial Equivalence to Predicate Device:
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Image /page/5/Picture/0 description: The image shows the word "ISOPURE" in blue, with a stylized image of water underneath. The word "ISOPURE" is in all capital letters and is the main focus of the image. The water image is a mix of blues and whites, giving the impression of movement and purity. The overall design is clean and simple, with a focus on the brand name and the association with water.
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11851 Plantside Drive Louisville, Kentucky 40299 502-267-7873 ● 800-280-PURE (7873) ● Fax: 502-297-5066 www.isopure.com
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Non-Clinical Performance Data:
Verification and validation protocols were designed to test each function of the Isopure Dry Acid Dissolution System and ensure it performed as intended. Any errors or failures detected during testing were corrected. Materials of construction chosen were the same or even more inert than those of the predicate device. All materials found in water distribution loops have been evaluated for material compatibility with Dry Acid mixed solution. Standard use conditions in the dialysis water room environment were simulated for all testing that was conducted. Performance of control-related filling, pressure, and temperature sensors was tested to verify correct function in each of their respective system processes. A summary of the Non-Clinical Performance data can be seen in the table below
Testing provided results that the system was capable of mixing dry acid powder with purified water as intended and is capable to producing an acid concentrate solution consistent with the powder manufacturer's specifications.
| Test | Attachment | Description |
|---|---|---|
| Low and High Ends ofSpecific GravityRange Mixing | X | Manufacturer pass/fail SG tables has min and max values for each prescription and different temperature points to accommodate variations in the manufacturing process. Bags could have more or less powder due to small variances in the process. The situation was simulated by adding or taking some powder away to come up with SG closer to the ranges provided by the |
| manufacturer. These solutions were analyzed using thenominal SG/HP ratio calculated in the Low / Medium / High SGtest to determine if the converted pass/fail table would stillpass or reject batches as efficiently as the manufacturer'soriginal pass/fail criteria. | ||
| Prescription Mixing | E | The test was used to verify the use of Hydrostatic Pressure(HP) as an indirect method of measuring HP and the use of aratio between Specific Gravity (SG) and HP to convert SGpass/fail tables provided by the manufacturer to a HP table.Tests performed in low, medium and high end of the SGspectrum. |
| The tests also went on to verify that the use of these ratioscould determine that an acid batch that should not meetspecifications, i.e. missing a bag, should result in a rejection forthat batch. This verified that the method to determine abatch's quality by the mixer is as good as the powdermanufacturer's original pass/fall criteria. | ||
| The tests also verified repeatability of HP readings. | ||
| Small Scale Effects ofAcid Powder onTemperature | S | This test determined how the water temperature wouldchange once acid powder had been added, independent of thesystem itself. This was completed on a small scale, using mixingpowder with 1 liter of water. |
| Large Scale Effects ofAcid Powder onTemperature | T | This test determined how the water temperature wouldchange when acid powder was added inside the system. It wascompleted using full sized batches inside the Isopure Dry AcidDissolution System. |
| Effects oftemperature onHydrostatic Pressure(HP) Sensor | M | The system was challenged with incoming water pressures atthe low and high ends of the manufacturer's recommendedworking temperatures (20° C and 30°C) to verify if the HPvalues would remain constant or if a temperaturecompensation algorithm would be required. |
| Self-Calibration | R | This test's purpose was to verify that the system couldaccommodate small variations in sensors over time and amongdifferent units in case of field replacements. |
| Transfer Process | U | The test verified that the transfer process is a repeatableprocess that results in most of the end product beingtransferred from the mixer into a separate storage tank.The transfer process relies on the system reading thepressure at different points and estimating the timeremaining based on the rate of emptying. |
| IFM Pressure sensor | N | This test's purpose was to verify linearity, accuracy andrepeatability of the HP sensor. |
| IFM Temperaturesensor | O | To verify linearity, accuracy and repeatability of thetemperature sensor. |
| Fill Sensor | V | This test was used to verify the repeatability of the fill sensor(also called Capacitive Sensor). |
| Bag OpenerReliability | Z | This test's purpose was to verify general components reliabilityand that the contents of the bags are consistently and fullydispensed into the system. The test also identified MTBFvalues as well as process failure points. |
| Disinfection andRinse | P | This test's purpose was to verify the methods used toincorporate Peracetic acid as a disinfectant into the systemand the corresponding rinsing methodologies. No disinfectionefficacy was tested assuming that the presence of the saidagents for the recommended contact times sufficed to provedisinfection. |
| MicrobiologicalDisinfection | Q | This test's purpose was to verify that the disinfection processfor the Isopure Dry Acid Dissolution System achieves at least3-log reduction of non-tuberculous bacteria and at least 6-logreduction of tuberculous bacteria within a maximumdisinfection time of 60 minutes. |
| Leaching Analysis | J | Assuming that the mixed solution could stay inside the MixingTank for up to 2 weeks, the system was challenged under thisscenario. Samples of the solutions pre and post exposure timeswere sent to an accredited laboratory for analysis. Generallyaccepted leaching studies were conducted. |
| Usability Engineering | L | This test's purpose was to analyze Human Factors normal UseCase scenarios were simulated after conducting a Task |
| Analysis. The main objective of the tests was to assess andmitigate Risks caused by Usability problems associatedwith the normal use of the device. Usability Goals weremet, and Risk Scores associated with Usability RelatedRisks were acceptable according to Isopure's RiskManagement SOP. | ||
| Noise Level | AA | This test's purpose was to verify that the noise producedby the system is kept below 90dB (excluding alert sounds) |
| Effects of IncomingWater Pressure onFill Level | W | This test's purpose was to determine what effects, if any,the incoming water pressure has on the fill level sensor'sperformance. |
Summary of Non-Clinical Performance Data
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Image /page/9/Picture/0 description: The image shows the word "ISOPURE" in blue, with a water graphic underneath. The water graphic is a close-up of water with bubbles and ripples. The word "ISOPURE" is in a sans-serif font and is slightly italicized. The overall effect is clean and refreshing.
11851 Plantside Drive Louisville, Kentucky 40299 502-267-7873 • 800-280-PURE (7873) • Fax: 502-297-5066 www.isopure.com
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Clinical Performance Data:
No clinical performance testing was required for determination of substantial equivalence of this type and class of device.
Conclusion:
The information and data provided in this 510(k) Notification establish that the Isopure Dry Acid Dissolution System is substantially equivalent to the legally marketed predicate device in relation to intended use, technological characteristics and operational characteristics.
§ 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.