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notwithstanding any termination of the Agreement or the suspension ortermination of Bank’s obligation to make loans and advances hereunder,including during any Streamline Period; and”and inserting in lieu thereof the following:“(d) Unused Revolving Line Facility Fee. A fee (the “**UnusedRevolving Line Facility Fee**”), payable monthly, in arrears, commencing withthe monthly period ended January 1, 2011, and each monthly period endingthereafter, on a calendar year basis, in an amount equal to one-quarter ofone percent (0.25%) per annum of the average unused portion of the RevolvingLine, as determined by Bank. The unused portion of the Revolving Line, forthe purposes of this calculation, shall not include amounts reserved forproducts provided in connection with Cash Management Services, FX ForwardContracts or Letters of Credit. Borrower shall not be entitled to anycredit, rebate or repayment of any Unused Revolving Line Facility Feepreviously earned by Bank pursuant to this Section notwithstanding anytermination of the Agreement or the suspension or termination of Bank’sobligation to make loans and advances hereunder, including during anyStreamline Period; and” 3 The Loan Agreement shall be amended by deleting the followingtext appearing as Section 6.2(a)(iii) thereof:“(iii) as soon as available, and in any event within thirty (30) days afterthe end of each month, monthly unaudited consolidated and consolidatingfinancial statements;”and inserting in lieu thereof the following:“(iii) for any month in which, as of any date of measurement in such month,Borrower’s unrestricted cash at Bank plus the unused AvailabilityAmount (as determined by Bank with reference to the most recent BorrowingBase Certificate of Borrower) is less than or equal to $20,000,000, then assoon as available, and in any event within thirty (30) days after the end ofeach such month, monthly unaudited consolidated and consolidating financialstatements;” 4 The Loan Agreement shall be amended by deleting the followingtext from Section 10 thereof:         “If to Bank:   Silicon Valley Bank      One Newton Executive Park,      Suite 200      2221 Washington Street      Newton, Massachusetts 02462      Attn: Mr. Ryan Ravenscroft      Fax: (617) 527-0177      Email: rravenscroft@svb.com”         and inserting in lieu thereof the following:         “If to Bank:   Silicon Valley Bank      275 Grove Street, Suite 2-200      Newton, Massachusetts 02466      Attn: Mr. Michael Quinn      Fax: (617) 527-0177      Email: mquinn@svb.com”4. FEES. Borrower shall pay to Bank the “Anniversary Fee” described in Section 2.4 of theLoan Agreement, as and when due and payable in accordance therewith. Borrower shall also reimburseBank for all legal fees and expenses incurred in connection with this amendment to the ExistingLoan Documents.
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5. CONSISTENT CHANGES. The Existing Loan Documents are hereby amended wherever necessaryto reflect the changes described above.6. RATIFICATION OF LOAN DOCUMENTS. Borrower hereby ratifies, confirms, and reaffirms allterms and conditions of the Loan Agreement (as modified hereby), each other Existing Loan Documentand all security or other collateral granted to the Bank, and confirms that the indebtednesssecured thereby includes, without limitation, the Obligations. Nothing in this Loan ModificationAgreement shall constitute a satisfaction of the Obligations. It is the intention of Bank andBorrower to retain as liable parties all makers of Existing Loan Documents, unless the party isexpressly released by Bank in writing. No maker will be released by virtue of this LoanModification Agreement.7. JURISDICTION/VENUE. Section 11 of the Loan Agreement is hereby incorporated byreference in its entirety.8. COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when itshall have been executed by Borrower and Bank.*[The remainder of this page is intentionally left blank]*
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     **IN WITNESS WHEREOF**, the parties hereto have caused this Loan Modification Agreement to beexecuted as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the datefirst above written.**BORROWER:**               NXSTAGE MEDICAL, INC.   EIR MEDICAL, INC.                 By   /s/ Robert S. Brown    By   /s/ Robert S. Brown               Name: Robert S. Brown     Name: Robert S. Brown    Title: Treasurer,SVP & CFO   Title: Treasurer                  MEDISYSTEMS CORPORATION   MEDISYSTEMS SERVICES CORPORATION                 By   /s/ Robert S. Brown    By   /s/ Robert S. Brown              Name: Robert S. Brown    Name: Robert S. Brown   Title: Treasurer    Title: Treasurer                  **BANK:**                           SILICON VALLEY BANK                         By   /s/ Michael Quinn                        Name: Michael Quinn           Title: VP           
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