EXELTRA HIGH FLUX DIALYZER, MODELS 150 & 170

K030974 · Baxter Healthcare Corp · KDI · Apr 25, 2003 · Gastroenterology, Urology

Device Facts

• Record ID: K030974
• Device Name: EXELTRA HIGH FLUX DIALYZER, MODELS 150 & 170
• Applicant: Baxter Healthcare Corp
• Product Code: KDI · Gastroenterology, Urology
• Decision Date: Apr 25, 2003
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.5860
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Hemodialysis with the EXELTRA™ Dialyzer is indicated for patients with acute or chronic renal failure when conservative therapy is judged to be inadequate. It also may be indicated in the treatment of patients intoxicated with poisons or drugs.

Device Story

EXELTRA™ 150 and 170 are single-use hemodialyzers; used for extracorporeal blood treatment in patients with renal failure or intoxication. Device functions as high-permeability hemodialysis system; facilitates solute removal and fluid management via semi-permeable membrane. Operated by trained clinical staff in dialysis settings. Output is treated blood returned to patient; clinical decision-making based on patient's metabolic status and dialysis prescription. Benefits include removal of uremic toxins and excess fluid.

Clinical Evidence

No clinical data. Bench testing only; includes biological evaluation per ISO 10993-1 and functional testing for blood side integrity and manufacturing specification conformance.

Technological Characteristics

High permeability hemodialysis system. Single-use. Gamma sterilization validated per AAMI/ISO 11137:1994. Materials meet ISO 10993-1 biological requirements.

Indications for Use

Indicated for patients with acute or chronic renal failure requiring hemodialysis when conservative therapy is inadequate, and for patients intoxicated with poisons or drugs.

Regulatory Classification

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).

Special Controls

*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.”

Predicate Devices

• Baxter CT Dialyzer, Single Use (K890315, K926568, K970663)

Submission Summary (Full Text)

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'APR 2 5 2003

K030974

Page 1/2

## 510(K) SUMMARY

| Submitter's Name: | David E. Curtin, RAC |
|-----------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Address: | 1620 Waukegan Rd. MPGR-A2E |
| Phone: | [phone] |
| Fax: | [phone] |
| Contact: | David E. Curtin |
| Date Prepared: | 3/27/03 |
| Trade Name: | EXELTRA™ Dialyzer, Single Use |
| Common Name: | Dialyzer |
| Classification Name: | High Permeability Hemodialysis System per 21 CFR 876.5860 |
| Equivalent Predicate: | Baxter CT Dialyzer, Single Use (K890315, K926568,<br>K970663) |
| Device Description: | Model EXELTRA™ 150 and 170 Single Use Dialyzers |
| Intended Use: | Hemodialysis with EXELTRA™ dialyzers is indicated for<br>patients with renal failure when conservative therapy is judged<br>to be inadequate. It also may be indicated in the treatment of<br>patients intoxicated with poisons or drugs. |
| Summary of the<br>Technological<br>Characteristics<br>Compared to the | The general design and material of the EXELTRA™ 150 and<br>170 single use dialyzers are similar to the CT 110 and CT190G<br>dialyzers cleared under K890315, K926568 and K970663, and<br>do not raise any new types of safety and effectiveness issues,<br>when compared to the predicate product. |
| Predicate Device: | Baxter CT Dialyzers |
| Clinical Data: | N/A |
| Conclusions Drawn | Components of the subject EXELTRATM dialyzers have met the biological requirements of ISO 10993-1: Biological Evaluation of Medical devices - Part: Guidance on selection of tests.<br><br>The validation of the gamma sterilization cycle for the EXELTRATM dialyzer is based upon the AAMI/ISO 11137:1994 "Sterilization of Healthcare Products – Requirements for Validation and Routine Control - Radiation Sterilization".<br><br>Functional testing for blood side integrity and conformance to manufacturing specifications are performed as in-process and/or final inspections prior to product release to ensure a quality product. |
| Additional Information<br>Requested by FDA: | None to date |

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510(k) Premarket Notification EXELTRA™ 150 and 170 Single Use Dialyzers Page 2 of 2

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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 with three curved lines forming its body and wings. The logo is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR 2 5 2003

David E. Curtin, RAC Associate Director, Regulatory Affairs Renal Division Baxter Healthcare Corporation 1620 Waukegan Road MCGAW PARK IL 60085

Re: K030974

Trade/Device Name: EXELTRA™ Dialyzer, Single Use, Models 150 and 170 Regulation Number: 21 CFR §876.5860 Regulation Name: High permeability hemodialysis system Regulatory Class: II Product Code: 78 KDI Dated: March 27, 2003 Received: March 28, 2003

Dear Mr. Curtin:

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 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:

| 8xx.1xxx | [phone] |
|----------------------------------|----------------|
| 876.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | [phone] |
| 892.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| Other | [phone] |

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). 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 [phone] or [phone] 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

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510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: EXELTRA™ Dialyzer

Indications For Use:

Hemodialysis with the EXELTRA™ Dialyzer is indicated for patients with acute or chronic renal failure when conservative therapy is judged to be inadequate. It also may be indicated in the treatment of patients intoxicated with poisons or drugs.

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

| | | Concurrence of CDRH/Office of Device Evaluation (ODE) |
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| | (Division Sign-Off) | |
| | | Division of Reproductive, Abdominal, and Radiological Devices |
| | 510(k) Number | k030974 |

| Prescription Use<br>(Per 21 CFR 801.109) | OR | Over-The-Counter Use |
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G:1510kVExcltra 170 Single Use Dialyzers\submission\Indications for Use Statement