Document:

Amendment, dated May 7, 2012, to the Loan and Security Agreement

 Exhibit 10.35 
 SECOND LOAN MODIFICATION AGREEMENT 
 This Second Loan
Modification Agreement (this “Loan Modification Agreement”) is entered into as of May 7, 2012, with an effective date as of April 1, 2012 (the “Second Loan Modification Effective Date”), by and between
(i) SILICON VALLEY BANK, a California corporation with a loan production office located at 275 Grove Street, Suite 2-200, Newton, Massachusetts 02466 (“Bank”), and ((ii) NXSTAGE MEDICAL, INC., a Delaware
corporation (“NxStage”), EIR MEDICAL, INC., a Massachusetts corporation (“EIR”), MEDISYSTEMS CORPORATION, a Washington corporation (“Medisystems”), each with offices located at 439
South Union Street, 5th Floor, Lawrence, Massachusetts
01843, and MEDISYSTEMS SERVICES CORPORATION, a Nevada corporation, (“Services”), with offices located at 101 Convention Center Drive, Suite 850, Las Vegas, Nevada 89101 (NxStage, EIR, Medisystems and Services are individually
and collectively, jointly and severally, the “Borrower”). 
 1. DESCRIPTION OF EXISTING INDEBTEDNESS AND OBLIGATIONS.
Among other indebtedness and obligations which may be owing by Borrower to Bank, Borrower is indebted to Bank pursuant to a loan arrangement dated as of March 10, 2010, evidenced by, among other documents, a certain Loan and Security Agreement
dated as of March 10, 2010, between Borrower and Bank, as amended by that certain First Loan Modification Agreement, dated as of March 29, 2011 (as amended, the “Loan Agreement”). Capitalized terms used but not otherwise
defined herein shall have the same meaning as in the Loan Agreement. 
 2. DESCRIPTION OF COLLATERAL. Repayment of the Obligations is
secured by the Collateral as described in the Loan Agreement and in certain Intellectual Property Security Agreements, each dated as of March 10, 2010 executed by each Borrower in favor of Bank (collectively, the “IP
Agreements”, and together with any other collateral security granted to Bank, the “Security Documents”). 

Hereinafter, the Security Documents, together with all other documents evidencing or securing the Obligations shall be referred to as the
“Existing Loan Documents”. 
 3. DESCRIPTION OF CHANGE IN TERMS. 

 

	 	A.	Modifications to Loan Agreement. 

  

	 	1	The Loan Agreement shall be amended by deleting Sections 2.1.2, 2.1.3 and 2.1.4 in their entirety. 

 

	 	2	The Loan Agreement shall be amended by deleting the following text appearing as Section 2.2 thereof: 

“2.2 Overadvances. If, at any time, the sum of (a) the outstanding principal amount of any Advances (including any
amounts used (and not re-paid) for Cash Management Services); plus (b) the face amount of any outstanding Letters of Credit (including drawn but unreimbursed Letters of Credit and any Letter of Credit Reserve); plus (c) the
FX Reduction Amount exceeds the lesser of either the Revolving Line or the Borrowing Base (such excess amount being an “Overadvance”), Borrower shall immediately pay to Bank in cash such Overadvance. Without limiting Borrower’s
obligation to repay Bank any amount of the Overadvance, Borrower agrees to pay Bank interest on the outstanding amount of any Overadvance if not paid when due on demand, at the Default Rate.” 

and inserting in lieu thereof the following: 
 “2.2 Overadvances. If, at any time, the outstanding principal amount of any Advances exceeds the lesser of either the Revolving Line or the Borrowing Base (such excess amount being an
“Overadvance”), Borrower shall immediately pay to Bank in cash such Overadvance. Without limiting Borrower’s obligation to repay Bank any amount of the Overadvance, Borrower agrees to pay Bank interest on the outstanding amount
of any Overadvance if not paid when due on demand, at the Default Rate.” 

  
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	 	3	The Loan Agreement shall be amended by deleting the following text appearing as Section 2.3(a)(i) thereof: 

“(i) Advances. Subject to Section 2.3(b), effective as of January 1, 2011 and thereafter, the principal amount
outstanding under the Revolving Line shall accrue interest at floating per annum rate equal to one-half of one percentage point (0.50%) above the Prime Rate, which interest shall be payable monthly, in arrears, in accordance with Section 2.3(f)
below.” 
 and inserting in lieu thereof the following: 

“(i) Advances. Subject to Section 2.3(b), the principal amount outstanding under the Revolving Line shall accrue
interest at floating per annum rate equal to the Prime Rate, which interest shall be payable monthly, in arrears, in accordance with Section 2.3(f) below.” 
  

	 	4	The Loan Agreement shall be amended by deleting the following text appearing as Section 2.4(b) thereof: 

“(b) Letter of Credit Fee. Bank’s customary fees and expenses for the issuance or renewal of Letters of Credit, upon the
issuance of such Letter of Credit, each anniversary of the issuance during the term of such Letter of Credit, and upon the renewal of such Letter of Credit by Bank;” 
 and inserting in lieu thereof the following: 
 “(b) [Reserved]; 

 

	 	5	The Loan Agreement shall be amended by deleting the following text appearing as Section 2.4(d) thereof: 

“(d) Unused Revolving Line Facility Fee. A fee (the “Unused Revolving Line Facility Fee”), payable monthly,
in arrears, commencing with the monthly period ended January 1, 2011, and each monthly period ending thereafter, on a calendar year basis, in an amount equal to one-quarter of one percent (0.25%) per annum of the average unused portion of the
Revolving Line, as determined by Bank. The unused portion of the Revolving Line, for the purposes of this calculation, shall not include amounts reserved for products provided in connection with Cash Management Services, FX Forward Contracts or
Letters of Credit. Borrower shall not be entitled to any credit, rebate or repayment of any Unused Revolving Line Facility Fee previously earned by Bank pursuant to this Section notwithstanding any termination of the Agreement or the suspension or
termination 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 “Unused Revolving Line Facility Fee”), payable monthly, in arrears, on a calendar year basis, in an amount equal to
one-quarter of one percent (0.25%) per annum of the average unused portion of the Revolving Line, as determined by Bank. Borrower shall not be entitled to any credit, rebate or repayment of any Unused Revolving Line Facility Fee previously earned by
Bank pursuant to this Section notwithstanding any termination of the Agreement or the suspension or termination of Bank’s obligation to make loans and advances hereunder, including during any Streamline Period; and” 

  
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	 	6	The Loan Agreement shall be amended by deleting the following text appearing as Section 3.4 thereof: 

“3.4 Procedures for Borrowing. Advances. Subject to the prior satisfaction of all other applicable conditions to the
making of an Advance set forth in this Agreement, to obtain an Advance (other than Advances under Sections 2.1.2 or 2.1.4), Borrower shall notify Bank (which notice shall be irrevocable) by electronic mail, facsimile, or telephone by 12:00 noon
Eastern time on the Funding Date of the Advance. Together with any such electronic or facsimile notification, Borrower shall deliver to Bank by electronic mail or facsimile a completed Transaction Report executed by a Responsible Officer or his or
her designee. Bank may rely on any telephone notice given by a person whom Bank reasonably believes is a Responsible Officer or designee. Bank shall credit Advances to the Designated Deposit Account. Bank may make Advances under this Agreement based
on instructions from a Responsible Officer or his or her designee or without instructions if the Advances are necessary to meet Obligations which have become due.” 
 and inserting in lieu thereof the following: 
 “3.4 Procedures for
Borrowing. Advances. Subject to the prior satisfaction of all other applicable conditions to the making of an Advance set forth in this Agreement, to obtain an Advance, Borrower shall notify Bank (which notice shall be irrevocable) by
electronic mail, facsimile, or telephone by 12:00 noon Eastern time on the Funding Date of the Advance. Together with any such electronic or facsimile notification, Borrower shall deliver to Bank by electronic mail or facsimile a completed
Transaction Report executed by a Responsible Officer or his or her designee. Bank may rely on any telephone notice given by a person whom Bank reasonably believes is a Responsible Officer or designee. Bank shall credit Advances to the Designated
Deposit Account. Bank may make Advances under this Agreement based on instructions from a Responsible Officer or his or her designee or without instructions if the Advances are necessary to meet Obligations which have become due.” 

 

	 	7	The Loan Agreement shall be amended by deleting the following text appearing as Section 4.1 thereof: 

“4.1 Grant of Security Interest. Borrower hereby grants Bank, to secure the payment and performance in full of all of the
Obligations, a continuing security interest in, and pledges to Bank, the Collateral, wherever located, whether now owned or hereafter acquired or arising, and all proceeds and products thereof.” 

and inserting in lieu thereof the following: 
 “4.1 Grant of Security Interest. Borrower hereby grants Bank, to secure the payment and performance in full of all of the Obligations, a continuing security interest in, and pledges to Bank,
the Collateral, wherever located, whether now owned or hereafter acquired or arising, and all proceeds and products thereof. 

Borrower acknowledges that it previously has entered, and/or may in the future enter, into Bank Services Agreements with Bank. Regardless
of the terms of any Bank Services Agreement, Borrower agrees that any amounts Borrower owes Bank thereunder shall be deemed to be Obligations hereunder and that it is the intent of Borrower and Bank to have all such Obligations secured by the first
priority perfected security interest in the Collateral granted herein (subject only to Permitted Liens that expressly have superior priority to Bank’s Lien in this Agreement). 

If this Agreement is terminated, Bank’s Lien in the Collateral shall continue until the Obligations (other than inchoate indemnity
obligations) are satisfied in full, and at such time, Bank shall, at Borrower’s sole cost and expense, terminate its security interest in the Collateral and all rights therein shall revert to Borrower. In the event (a) all Obligations
(other than inchoate indemnity obligations), except for Bank Services, are satisfied in full, and (b) this Agreement is terminated, Bank shall terminate the security interest granted herein upon Borrower providing cash collateral acceptable to
Bank in its 

  
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good faith business judgment for Bank Services, if any. In the event such Bank Services consist of outstanding letters of credit, Borrower shall provide to Bank cash collateral in an amount equal
to 105% (110% for letters of credit denominated in a currency other than Dollars), of the Dollar Equivalent of the face amount of all such letters of credit plus all interest, fees, and costs due or to become due in connection therewith (as
estimated by Bank in its good faith business judgment), to secure all of the Obligations relating to such letters of credit.” 
  

	 	8	The Loan Agreement shall be amended by deleting the following text appearing as Section 4.2 thereof: 

“4.2 Priority of Security Interest. Borrower represents, warrants, and covenants that the security interest granted herein is
and shall at all times continue to be a first priority perfected security interest in the Collateral (subject only to Permitted Liens that may have superior priority to Bank’s Lien under this Agreement and the Asahi Intercreditor Agreement). If
Borrower shall acquire a commercial tort claim in excess of Two Hundred Fifty Thousand Dollars ($250,000), Borrower shall promptly notify Bank in a writing signed by Borrower of the general details thereof and grant to Bank in such writing a
security interest therein and in the proceeds thereof, all upon the terms of this Agreement, with such writing to be in form and substance reasonably satisfactory to Bank. 
 If this Agreement is terminated, Bank’s Lien in the Collateral shall continue until the Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms, are to
survive the termination of this Agreement) are repaid in full in cash. Upon payment in full in cash of the Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the termination of this
Agreement) and at such time as Bank’s obligation to make Credit Extensions has terminated, Bank shall, at Borrower’s sole cost and expense, release its Liens in the Collateral and all rights therein shall revert to Borrower.”

 and inserting in lieu thereof the following: 
 “4.2 Priority of Security Interest. Borrower represents, warrants, and covenants that the security interest granted herein is and shall at all times continue to be a first priority perfected
security interest in the Collateral (subject only to Permitted Liens that may have superior priority to Bank’s Lien under this Agreement). If Borrower shall acquire a commercial tort claim in excess of Two Hundred Fifty Thousand Dollars
($250,000), Borrower shall promptly notify Bank in a writing signed by Borrower of the general details thereof and grant to Bank in such writing a security interest therein and in the proceeds thereof, all upon the terms of this Agreement, with such
writing to be in form and substance reasonably satisfactory to Bank.” 
  

	 	9	The Loan Agreement shall be amended by deleting the following text appearing as Section 6.4 thereof: 

“6.4 Remittance of Proceeds. Subject to the Asahi Intercreditor Agreement, except as otherwise provided in
Section 6.3(c), deliver, in kind, all proceeds arising from the disposition of any Collateral with respect to which Bank has a senior lien, to Bank in the original form in which received by Borrower not later than the following Business Day
after receipt by Borrower, to be applied to the Obligations pursuant to the terms of Section 9.4 hereof; provided that, if no Default or Event of Default has occurred and is continuing, Borrower shall not be obligated to remit to Bank the
proceeds of the sale of worn out, excess or obsolete Equipment disposed of by Borrower in good faith in an arm’s length transaction for an aggregate purchase price of One Hundred Thousand Dollars ($100,000) or less (for all such transactions in
any fiscal year) or the proceeds of Transfers permitted under Section 7.1 hereof. Borrower agrees that it will not commingle proceeds of Collateral with any of Borrower’s other funds or property, but will hold such

  
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proceeds separate and apart from such other funds and property and in an express trust for Bank, subject to the Asahi Intercreditor Agreement. Nothing in this Section limits the restrictions on
disposition of Collateral set forth elsewhere in this Agreement.” 
 and inserting in lieu thereof the following:

 “6.4 Remittance of Proceeds. Except as otherwise provided in Section 6.3(c), deliver, in kind, all proceeds
arising from the disposition of any Collateral with respect to which Bank has a senior lien, to Bank in the original form in which received by Borrower not later than the following Business Day after receipt by Borrower, to be applied to the
Obligations pursuant to the terms of Section 9.4 hereof; provided that, if no Default or Event of Default has occurred and is continuing, Borrower shall not be obligated to remit to Bank the proceeds of the sale of worn out, excess or obsolete
Equipment disposed of by Borrower in good faith in an arm’s length transaction for an aggregate purchase price of One Hundred Thousand Dollars ($100,000) or less (for all such transactions in any fiscal year) or the proceeds of Transfers
permitted under Section 7.1 hereof. Borrower agrees that it will not commingle proceeds of Collateral with any of Borrower’s other funds or property, but will hold such proceeds separate and apart from such other funds and property and in
an express trust for Bank. Nothing in this Section limits the restrictions on disposition of Collateral set forth elsewhere in this Agreement.” 
  

	 	10	The Loan Agreement shall be amended by deleting the following text appearing as Section 6.6 thereof: 

“6.6 Access to Collateral; Books and Records. At reasonable times, on three (3) Business Days’ notice (provided no
notice is required if an Event of Default has occurred and is continuing), Bank, or its agents, shall have the right, on a semi-annual basis (or more frequently as conditions warrant, in Bank’s reasonable discretion), to inspect the Collateral
and the right to audit and copy Borrower’s Books. The foregoing inspections and audits shall be at Borrower’s expense, and the charge therefor shall be $850 per person per day (or such higher amount as shall represent Bank’s
then-current standard charge for the same), plus reasonable out-of-pocket expenses. In the event Borrower and Bank schedule an audit more than ten (10) days in advance, and Borrower cancels or seeks to reschedules the audit with less than ten
(10) days written notice to Bank, then (without limiting any of Bank’s rights or remedies), Borrower shall pay Bank a fee of $1,000 plus any reasonable out-of-pocket expenses incurred by Bank to compensate Bank for the anticipated costs
and expenses of the cancellation or rescheduling.” 
 and inserting in lieu thereof the following: 

6.6 Access to Collateral; Books and Records. At reasonable times, on three (3) Business Days’ notice (provided no notice
is required if an Event of Default has occurred and is continuing), Bank, or its agents, shall have the right, on an annual basis (or more frequently as conditions warrant, in Bank’s reasonable discretion), to inspect the Collateral and the
right to audit and copy Borrower’s Books. The foregoing inspections and audits shall be at Borrower’s expense, and the charge therefor shall be $850 per person per day (or such higher amount as shall represent Bank’s then-current
standard charge for the same), plus reasonable out-of-pocket expenses. In the event Borrower and Bank schedule an audit more than ten (10) days in advance, and Borrower cancels or seeks to reschedules the audit with less than ten (10) days
written notice to Bank, then (without limiting any of Bank’s rights or remedies), Borrower shall pay Bank a fee of $1,000 plus any reasonable out-of-pocket expenses incurred by Bank to compensate Bank for the anticipated costs and expenses of
the cancellation or rescheduling.” 

  
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	 	11	The Loan Agreement shall be amended by deleting the following text appearing as Section 6.7 thereof: 

“6.7 Insurance. Keep its business and the Collateral insured for risks and in amounts standard for companies in
Borrower’s industry and location and as Bank may reasonably request. Insurance policies shall be in a form, with companies, and in amounts that are reasonably satisfactory to Bank. All property policies shall have a lender’s loss payable
endorsement showing Bank as an additional lender loss payee and waive subrogation against Bank and shall provide that the insurer must give Bank at least twenty (20) days notice before canceling, amending, or declining to renew its policy. All
liability policies shall show, or have endorsements showing, Bank as an additional insured, and all such policies (or the loss payable and additional insured endorsements) shall provide that the insurer shall give Bank at least twenty (20) days
notice before canceling, amending, or declining to renew its policy. At Bank’s request, Borrower shall deliver certified copies of policies and evidence of all premium payments. Proceeds payable under any policy with respect to any Collateral
as to which the Bank’s Lien is senior to that of Asahi pursuant to the Asahi Intercreditor Agreement shall, at Bank’s option, be payable to Bank on account of the Obligations. Notwithstanding the foregoing, (a) so long as no Event of
Default has occurred and is continuing, Borrower shall have the option of applying the proceeds of any casualty policy up to Two Hundred Fifty Thousand Dollars ($250,000) with respect to any loss, toward the replacement or repair of destroyed or
damaged property; provided that any such replaced or repaired property (i) shall be of equal or like value as the replaced or repaired Collateral and (ii) shall be deemed Collateral in which Bank has been granted a security interest, and
(b) after the occurrence and during the continuance of an Event of Default, all proceeds payable under such casualty policy shall, at the option of Bank, be payable to Bank on account of the Obligations. If Borrower fails to obtain insurance as
required under this Section 6.7 or to pay any amount or furnish any required proof of payment to third persons and Bank, Bank may make all or part of such payment or obtain such insurance policies required in this Section 6.7, and take any
action under the policies Bank deems prudent.” 
 and inserting in lieu thereof the following: 

“6.7 Insurance. Keep its business and the Collateral insured for risks and in amounts standard for companies in
Borrower’s industry and location and as Bank may reasonably request. Insurance policies shall be in a form, with companies, and in amounts that are reasonably satisfactory to Bank. All property policies shall have a lender’s loss payable
endorsement showing Bank as an additional lender loss payee and waive subrogation against Bank and shall provide that the insurer must give Bank at least twenty (20) days’ notice before canceling, amending, or declining to renew its
policy. All liability policies shall show, or have endorsements showing, Bank as an additional insured, and all such policies (or the loss payable and additional insured endorsements) shall provide that the insurer shall give Bank at least twenty
(20) days’ notice before canceling, amending, or declining to renew its policy. At Bank’s request, Borrower shall deliver certified copies of policies and evidence of all premium payments. Proceeds payable under any policy with
respect to any Collateral shall, at Bank’s option, be payable to Bank on account of the Obligations. Notwithstanding the foregoing, (a) so long as no Event of Default has occurred and is continuing, Borrower shall have the option of
applying the proceeds of any casualty policy up to Two Hundred Fifty Thousand Dollars ($250,000) with respect to any loss, toward the replacement or repair of destroyed or damaged property; provided that any such replaced or repaired property
(i) shall be of equal or like value as the replaced or repaired Collateral and (ii) shall be deemed Collateral in which Bank has been granted a security interest, and (b) after the occurrence and during the continuance of an Event of
Default, all proceeds payable under such casualty policy shall, at the option of Bank, be payable to Bank on account of the Obligations. If Borrower fails to obtain insurance as required under this Section 6.7 or to pay any amount or furnish
any required proof of payment to third persons and Bank, Bank may make all or part of such payment or obtain such insurance policies required in this Section 6.7, and take any action under the policies Bank deems prudent.” 

  
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	 	12	The Loan Agreement shall be amended by deleting the following text appearing as Section 6.9(a) thereof: 

“(a) Adjusted EBITDA. Achieve a minimum Adjusted EBITDA (maximum loss), measured on a quarterly basis for each quarterly
period ending date listed below, in an amount not less than (max loss not greater than) the corresponding amount listed below for such quarterly period: 
  

					
	Quarterly Period Ending	  	Minimum Adjusted EBITDA
(maximum loss)	 
	 March 31, 2010
	  	 	($2,250,000	) 
	 June 30, 2010
	  	 	($1,250,000	) 
	 September 30, 2010
	  	 	($500,000	) 
	 December 31, 2010
	  	 	$1.00	  
	 March 31, 2011, and each quarterly period ending thereafter
	  	 	$500,000”	  

 and inserting in lieu thereof the following: 

“(a) Adjusted EBITDA. Achieve a minimum Adjusted EBITDA, measured on a quarterly basis for each quarterly period ending date
listed below, in an amount not less than the corresponding amount listed below for such quarterly period: 
  

					
	Quarterly Period Ending	  	Minimum Adjusted EBITDA	 
	 March 31, 2012
	  	 	$1.00	  
	 June 30, 2012
	  	 	$1.00	  
	 September 30, 2012, and each quarterly period ending thereafter
	  	 	$500,000”	  

  

	 	13	The Loan Agreement shall be amended by deleting the following text appearing as Section 6.10(b) and (c) thereof: 

“(b) If Borrower (i) obtains any Patent, registered Trademark, registered Copyright, registered mask work, or any pending
application for any of the foregoing, or (ii) applies for any Patent or the registration of any Trademark, then Borrower shall, on a quarterly basis, provide written notice thereof to Bank and shall execute such intellectual property security
agreements and other documents and take such other actions as Bank shall reasonably request in its good faith business judgment to perfect and maintain a perfected security interest in favor of Bank in such property, subject to the Asahi
Intercreditor Agreement. If Borrower decides to register any Copyrights or mask works in the United States Copyright Office, Borrower shall: (x) provide Bank with at least fifteen (15) days prior written notice of Borrower’s intent to
register such Copyrights or mask works together with a copy of the application it intends to file with the United States Copyright Office (excluding exhibits thereto); (y) execute an intellectual property security agreement and such other
documents and take such other actions as Bank may reasonably request to perfect and maintain a perfected security interest in favor of Bank in the 

  
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Copyrights or mask works intended to be registered with the United States Copyright Office, subject to the Asahi Intercreditor Agreement; and (z) record any such intellectual property
security agreement with the United States Copyright Office contemporaneously with filing the Copyright or mask work application(s) with the United States Copyright Office. Upon request, Borrower shall provide to Bank copies of all applications that
it files for Patents or for the registration of Trademarks, Copyrights or mask works, and will promptly provide Bank with evidence of the recording of the intellectual property security agreement necessary for Bank to perfect and maintain a security
interest in such property. 
 (c) Provide written notice to Bank within ten (10) Business Days of entering or becoming
bound by any Restricted License (other than open source or over-the-counter software that is commercially available to the public and other than the Utterberg License). Borrower shall make commercially reasonable efforts upon request of Bank to
obtain the consent of, or waiver by, any person whose consent or waiver is necessary for (i) any Restricted License (other than open source or over-the-counter software that is commercially available to the public and the Utterberg License) to
be deemed “Collateral” and for Bank to have a security interest in it that would be reasonably expected to otherwise be restricted or prohibited by law or by the terms of any such Restricted License, whether now existing or entered into in
the future, and (ii) subject to the Asahi Intercreditor Agreement, Bank to have the ability in the event of a liquidation of any Collateral to dispose of such Restricted License (other than open source or over-the-counter software that is
commercially available to the public and other than the Utterberg License) in accordance with Bank’s rights and remedies under this Agreement and the other Loan Documents.” 

and inserting in lieu thereof the following: 
 “(b) If Borrower (i) obtains any Patent, registered Trademark, registered Copyright, registered mask work, or any pending application for any of the foregoing, or (ii) applies for any
Patent or the registration of any Trademark, then Borrower shall, on a quarterly basis, provide written notice thereof to Bank and shall execute such intellectual property security agreements and other documents and take such other actions as Bank
shall reasonably request in its good faith business judgment to perfect and maintain a perfected security interest in favor of Bank in such property. If Borrower decides to register any Copyrights or mask works in the United States Copyright Office,
Borrower shall: (x) provide Bank with at least fifteen (15) days prior written notice of Borrower’s intent to register such Copyrights or mask works together with a copy of the application it intends to file with the United States
Copyright Office (excluding exhibits thereto); (y) execute an intellectual property security agreement and such other documents and take such other actions as Bank may reasonably request to perfect and maintain a perfected security interest in
favor of Bank in the Copyrights or mask works intended to be registered with the United States Copyright Office; and (z) record any such intellectual property security agreement with the United States Copyright Office contemporaneously with
filing the Copyright or mask work application(s) with the United States Copyright Office. Upon request, Borrower shall provide to Bank copies of all applications that it files for Patents or for the registration of Trademarks, Copyrights or mask
works, and will promptly provide Bank with evidence of the recording of the intellectual property security agreement necessary for Bank to perfect and maintain a security interest in such property. 

(c) Provide written notice to Bank within ten (10) Business Days of entering or becoming bound by any Restricted License (other than
open source or over-the-counter software that is commercially available to the public and other than the Utterberg License). Borrower shall make commercially reasonable efforts upon request of Bank to obtain the consent of, or waiver by, any person
whose consent or waiver is necessary for (i) any Restricted License (other than open source or over-the-counter software that is commercially available to the public and the Utterberg License) to be deemed “Collateral” and for Bank to
have a security interest in it that would be reasonably 

  
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expected to otherwise be restricted or prohibited by law or by the terms of any such Restricted License, whether now existing or entered into in the future, and (ii) Bank to have the ability
in the event of a liquidation of any Collateral to dispose of such Restricted License (other than open source or over-the-counter software that is commercially available to the public and other than the Utterberg License) in accordance with
Bank’s rights and remedies under this Agreement and the other Loan Documents.” 
  

	 	14	The Loan Agreement shall be amended by deleting the following text appearing as Section 7.5 thereof: 

“7.5 Encumbrance. Create, incur, allow, or suffer any Lien on any of the Collateral, or assign or convey any right to receive
income, including the sale of any Accounts, or permit any of its Subsidiaries to do so, except for Permitted Liens, permit any Collateral not to be subject to the first priority security interest granted herein (other than as stated in the Asahi
Intercreditor Agreement and other Permitted Liens which are entitled to priority) or enter into any agreement, document, instrument or other arrangement (except with or in favor of Bank or Asahi) with any Person which directly or indirectly
prohibits or has the effect of prohibiting Borrower or any Subsidiary from assigning, mortgaging, pledging, granting a security interest in or upon, or encumbering any of Borrower’s or any Subsidiary’s Intellectual Property, except as is
otherwise permitted in Section 7.1 hereof and the definition of “Permitted Liens” herein.” 
 and inserting
in lieu thereof the following: 
 “7.5 Encumbrance. Create, incur, allow, or suffer any Lien on any of the
Collateral, or assign or convey any right to receive income, including the sale of any Accounts, or permit any of its Subsidiaries to do so, except for Permitted Liens, permit any Collateral not to be subject to the first priority security interest
granted herein (other Permitted Liens which are entitled to priority) or enter into any agreement, document, instrument or other arrangement (except with or in favor of Bank) with any Person which directly or indirectly prohibits or has the effect
of prohibiting Borrower or any Subsidiary from assigning, mortgaging, pledging, granting a security interest in or upon, or encumbering any of Borrower’s or any Subsidiary’s Intellectual Property, except as is otherwise permitted in
Section 7.1 hereof and the definition of “Permitted Liens” herein.” 
  

	 	15	The Loan Agreement shall be amended by deleting the following text appearing as Section 8.6 thereof: 

“8.6 Other Agreements. There is, under any agreement to which Borrower or any Guarantor is a party with a third party or
parties, (a) any default resulting in a right by such third party or parties (other than the Asahi Term Loan), whether or not exercised, to accelerate the maturity of any Indebtedness in an amount individually or in the aggregate in excess of
Five Hundred Thousand Dollars ($500,000); (b) a default occurs by Borrower under the Asahi Term Loan and any applicable grace and cure periods have expired; or (c) any default by Borrower, the result of which would reasonably be expected
to have a material adverse effect on Borrower’s business, taken as a whole;” 
 and inserting in lieu thereof the
following: 
 “8.6 Other Agreements. There is, under any agreement to which Borrower or any Guarantor is a party
with a third party or parties, (a) any default resulting in a right by such third party or parties, whether or not exercised, to accelerate the maturity of any Indebtedness in an amount individually or in the aggregate in excess of Five Hundred
Thousand Dollars ($500,000); or (b) any default by Borrower, the result of which would reasonably be expected to have a material adverse effect on Borrower’s business, taken as a whole;” 

  
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	 	16	The Loan Agreement shall be amended by deleting the following text appearing as Section 8.9 thereof: 

“8.9 Subordinated Debt/Asahi Intercreditor Agreement. Any document, instrument, or any intercreditor or subordination
agreement relating to Subordinated Debt (including the Asahi Intercreditor Agreement), shall for any reason be revoked or invalidated or otherwise cease to be in full force and effect except in accordance with its terms or as a result of Bank’s
bad faith or willful misconduct, any Person other than Bank shall be in material breach thereof or contest in any manner the validity or enforceability thereof or deny that it has any further liability or obligation thereunder except in accordance
with its terms, or the Obligations shall for any reason be subordinated or shall not have the priority contemplated by this Agreement or the Asahi Intercreditor Agreement;” 

and inserting in lieu thereof the following: 
 “8.9 Subordinated Debt. Any document, instrument, or any intercreditor or subordination agreement relating to Subordinated Debt, shall for any reason be revoked or invalidated or otherwise
cease to be in full force and effect except in accordance with its terms or as a result of Bank’s bad faith or willful misconduct, any Person other than Bank shall be in material breach thereof or contest in any manner the validity or
enforceability thereof or deny that it has any further liability or obligation thereunder except in accordance with its terms, or the Obligations shall for any reason be subordinated or shall not have the priority contemplated by this
Agreement;” 
  

	 	17	The Loan Agreement shall be amended by deleting the following text appearing as Section 8.12 thereof: 

“8.12 Notice of Exclusive Control. The delivery by Asahi to Bank, Bank’s Affiliates or any other bank or financial
institution of a “Notice of Exclusive Control” or an “entitlement order” (as such term is defined in Article 8 of the Code), pursuant to any Collateral Account of the Borrower.” 

and inserting in lieu thereof the following: 
 “8.12 Notice of Exclusive Control. The delivery by any third party to Bank, Bank’s Affiliates or any other bank or financial institution of a “Notice of Exclusive Control” or an
“entitlement order” (as such term is defined in Article 8 of the Code), pursuant to any Collateral Account of the Borrower.” 
  

	 	18	The Loan Agreement shall be amended by deleting the following text appearing in Section 9.1 thereof: 

“9.1 Rights and Remedies. While an Event of Default occurs and continues Bank may, without notice or demand, do any or all of
the following, and in each case subject to the Asahi Intercreditor Agreement:” 
 and inserting in lieu thereof the
following: 
 “9.1 Rights and Remedies. While an Event of Default occurs and continues Bank may, without notice or
demand, do any or all of the following:” 
  

	 	19	The Loan Agreement shall be amended by deleting the following text appearing as clauses (c) and (d) in Section 9.1 thereof: 

“(c) demand that Borrower (i) deposit cash with Bank in an amount equal to 105% of the Dollar Equivalent of the aggregate face
amount of all Letters of Credit remaining 

  
 10 

 
undrawn plus all interest, fees, and costs due or to become due in connection therewith (as estimated by Bank in its good faith business judgment), to secure all of the Obligations relating to
such Letters of Credit, as collateral security for the repayment of any future drawings under such Letters of Credit, and Borrower shall forthwith deposit and pay such amounts, and (ii) pay in advance all letter of credit fees scheduled to be
paid or payable over the remaining term of any Letters of Credit; provided, however, if an Event of Default described in Section 8.5 occurs, the obligation of Borrower to cash collateralize all Letters of Credit remaining
undrawn shall automatically become effective without any action by Bank; 
 (d) terminate any FX Forward Contracts;”

 and inserting in lieu thereof the following: 
 “(c) demand that Borrower (i) deposit cash with Bank in an amount equal to 105% of the Dollar Equivalent of the aggregate face amount of all letters of credit which are Credit Extensions
remaining undrawn plus all interest, fees, and costs due or to become due in connection therewith (as estimated by Bank in its good faith business judgment), to secure all of the Obligations relating to such letters of credit, as collateral security
for the repayment of any future drawings under such letters of credit, and Borrower shall forthwith deposit and pay such amounts, and (ii) pay in advance all letter of credit fees scheduled to be paid or payable over the remaining term of any
letters of credit which are Credit Extensions; provided, however, if an Event of Default described in Section 8.5 occurs, the obligation of Borrower to cash collateralize all letters of credit which are Credit Extensions
remaining undrawn shall automatically become effective without any action by Bank; 
 (d) terminate any foreign exchange forward
contracts which are Credit Extensions;” 
  

	 	20	The Loan Agreement shall be amended by deleting the following text appearing as Section 9.4 thereof: 

“9.4 Application of Payments and Proceeds. Unless an Event of Default has occurred and is continuing, and subject to
Section 2.5 hereof and the Asahi Intercreditor Agreement, Bank may apply any funds in its possession, whether from Borrower account balances, payments, or proceeds realized as the result of any collection of Accounts or other disposition of the
Collateral, first, to Bank Expenses, including without limitation, the reasonable costs, expenses, liabilities, obligations and attorneys’ fees incurred by Bank in the exercise of its rights under this Agreement; second, to the interest due
upon any of the Obligations; and third, to the principal of the Obligations and any applicable fees and other charges, in such order as Bank shall determine in its sole discretion. Any surplus shall be paid to Borrower or other Persons legally
entitled thereto; Borrower shall remain liable to Bank for any deficiency. If an Event of Default has occurred and is continuing, and subject to Section 2.5 hereof and the Asahi Intercreditor Agreement, Bank may apply any funds in its
possession, whether from Borrower account balances, payments, proceeds realized as the result of any collection of Accounts or other disposition of the Collateral, or otherwise, to the Obligations in such order as Bank shall determine in its sole
discretion. Any surplus shall be paid to Borrower or to other Persons legally entitled thereto; Borrower shall remain liable to Bank for any deficiency. If Bank, in its good faith business judgment, directly or indirectly enters into a deferred
payment or other credit transaction with any purchaser at any sale of Collateral, Bank shall have the option, exercisable at any time, of either reducing the Obligations by the principal amount of the purchase price or deferring the reduction of the
Obligations until the actual receipt by Bank of cash therefor.” 
 and inserting in lieu thereof the following: 

  
 11 

 “9.4 Application of Payments and Proceeds. If an Event of Default has occurred
and is continuing, and subject to Section 2.5 hereof, Bank may apply any funds in its possession, whether from Borrower account balances, payments, proceeds realized as the result of any collection of Accounts or other disposition of the
Collateral, or otherwise, to the Obligations in such order as Bank shall determine in its sole discretion. Any surplus shall be paid to Borrower or to other Persons legally entitled thereto; Borrower shall remain liable to Bank for any deficiency.
If Bank, in its good faith business judgment, directly or indirectly enters into a deferred payment or other credit transaction with any purchaser at any sale of Collateral, Bank shall have the option, exercisable at any time, of either reducing the
Obligations by the principal amount of the purchase price or deferring the reduction of the Obligations until the actual receipt by Bank of cash therefor.” 
  

	 	21	The Loan Agreement shall be amended by deleting the following text appearing as Section 12.1 thereof: 

“12.1 Termination Prior to Maturity Date. This Agreement may be terminated prior to the Revolving Line Maturity Date by
Borrower, effective three (3) Business Days after written notice of termination is given to Bank or if Bank’s obligation to fund Credit Extensions terminates pursuant to the terms of Section 2.1.1(b). Notwithstanding any such
termination, Bank’s lien and security interest in the Collateral shall continue until Borrower fully satisfies its Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the
termination of this Agreement). If such termination is at Borrower’s election, Borrower shall pay to Bank, in addition to the payment of any other expenses or fees then-owing, a termination fee equal to (i) if terminated at any time prior
to the first anniversary of the Effective Date, an amount equal to one percent (1.00%) of the Revolving Line (i.e. One Hundred Fifty Thousand Dollars ($150,000)); (ii) if terminated on or at any time after the first anniversary of the
Effective Date but prior to the second anniversary of the Effective Date, an amount equal to one-half of one percent (0.50%) of the Revolving Line (i.e. Seventy Five Thousand Dollars ($75,000)); and from the second anniversary of the Effective Date
and thereafter, Zero Dollars ($0.00); provided that no termination fee shall be charged if the credit facility hereunder is replaced with a new or amended and restated facility from Silicon Valley Bank. Upon payment in full of the Obligations
(other than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the termination of this Agreement) and at such time as Bank’s obligation to make Credit Extensions has terminated, Bank shall release its
liens and security interests in the Collateral and all rights therein shall revert to Borrower.” 
 and inserting in lieu
thereof the following: 
 “12.1 Termination Prior to Maturity Date. This Agreement may be terminated prior to the
Revolving Line Maturity Date by Borrower, effective three (3) Business Days after written notice of termination is given to Bank or if Bank’s obligation to fund Credit Extensions terminates pursuant to the terms of Section 2.1.1(b).
Notwithstanding any such termination, Bank’s lien and security interest in the Collateral shall continue until Borrower fully satisfies its Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms,
are to survive the termination of this Agreement). If such termination is at Borrower’s election, Borrower shall pay to Bank, in addition to the payment of any other expenses or fees then-owing, a termination fee equal to (i) if terminated
at any time prior to the first anniversary of the Second Loan Modification Effective Date, an amount equal to one-half of one percent (0.50%) of the Revolving Line (i.e. Seventy Five Thousand Dollars ($75,000)); and (ii) from the first
anniversary of the Second Loan Modification Effective Date and thereafter, Zero Dollars ($0.00); provided that no termination fee shall be charged if the credit facility hereunder is replaced with a new or amended and restated facility from
Silicon Valley Bank. Upon payment in full of the Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the termination of this Agreement) and at such time as Bank’s obligation to
make Credit Extensions has terminated, Bank shall release its liens and security interests in the Collateral and all rights therein shall revert to Borrower.” 

  
 12 

	 	22	The Loan Agreement shall be amended by deleting the following text appearing as Section 12.9 thereof: 

“12.9 Survival. All covenants, representations and warranties made in this Agreement continue in full force until this
Agreement has terminated pursuant to its terms and all Obligations (other than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the termination of this Agreement) have been paid in full and satisfied.
The obligation of Borrower in Section 12.3 to indemnify Bank shall survive until the statute of limitations with respect to such claim or cause of action shall have run.” 

and inserting in lieu thereof the following: 
 “12.9 Survival. All covenants, representations and warranties made in this Agreement continue in full force until this Agreement has terminated pursuant to its terms and all Obligations (other
than inchoate indemnity obligations and any other obligations which, by their terms, are to survive the termination of this Agreement) have been paid in full and satisfied. Without limiting the foregoing, except as otherwise provided in
Section 4.1, the grant of security interest by Borrower in Section 4.1 shall survive until the termination of all Bank Services Agreements. The obligation of Borrower in Section 12.3 to indemnify Bank shall survive until the statute
of limitations with respect to such claim or cause of action shall have run. 
  

	 	23	The Loan Agreement shall be amended by inserting the following new definitions in Section 13.1 thereof, each in its appropriate alphabetical order:

 ““Bank Services” are any products, credit services, and/or financial accommodations
previously, now, or hereafter provided to Borrower or any of its Subsidiaries by Bank or any Bank Affiliate, including, without limitation, any letters of credit, cash management services (including, without limitation, merchant services, direct
deposit of payroll, business credit cards, and check cashing services), interest rate swap arrangements, and foreign exchange services as any such products or services may be identified in Bank’s various agreements related thereto (each, a
“Bank Services Agreement”). 
 “Second Loan Modification Effective Date” is April 1,
2012.” 
  

	 	24	The Loan Agreement shall be amended by deleting the following definitions appearing in Section 13.1 thereof: 

““Availability Amount” is (a) the lesser of (i) the Revolving Line or (ii) the amount available
under the Borrowing Base minus (b) the Dollar Equivalent amount of all outstanding Letters of Credit (including drawn but unreimbursed Letters of Credit plus an amount equal to the Letter of Credit Reserve), minus (c) the FX
Reduction Amount, minus (d) any amounts used for Cash Management Services, and minus (e) the outstanding principal balance of any Advances. 
 “Credit Extension” is any Advance, Letter of Credit, FX Forward Contract, amount utilized for Cash Management Services, or any other extension of credit by Bank for Borrower’s
benefit. 
 “Loan Documents” are, collectively, this Agreement, the IP Agreement, the Asahi Intercreditor
Agreement, any note, or notes or guaranties executed by Borrower or any Guarantor, and any other present or future agreement between Borrower or any Guarantor and/or for the benefit of Bank in connection with this Agreement, all as amended,
restated, or otherwise modified. 

  
 13 

 “Prime Rate” is the greater of (i) four percent (4.00%) per
annum and (ii) Bank’s most recently announced “prime rate,” even if it is not Bank’s lowest rate. 

“Reserves” means, as of any date of determination, such amounts as Bank may, from time to time, reasonably establish and
revise in good faith, after consultation with Borrower and on one (1) Business Day’s notice reducing the amount of Advances, Letters of Credit and other financial accommodations which would otherwise be available to Borrower under the
lending formulas: (a) to reflect events, conditions, contingencies or risks which, as determined by Bank in good faith, do or may affect (i) the Collateral or any other property which is security for the Obligations or its value (including
without limitation any increase in delinquencies of Accounts), (ii) the assets or business of Borrower or any guarantor, or (iii) the security interests and other rights of Bank in the Collateral (including the enforceability, perfection
and priority thereof); or (b) to reflect Bank’s good faith belief that any collateral report or financial information furnished by or on behalf of Borrower or any guarantor to Bank is or may have been incomplete, inaccurate or misleading
in any material respect; or (c) in respect of any state of facts which Bank determines in good faith constitutes an Event of Default or may, with notice or passage of time or both, constitute an Event of Default. 

“Revolving Line Maturity Date” is April 1, 2012.” 

and inserting in lieu thereof the following: 
 ““Availability Amount” is (a) the lesser of (i) the Revolving Line or (ii) the amount available under the Borrowing Base minus (b) the outstanding
principal balance of any Advances. 
 “Credit Extension” is any Advance, letter of credit, foreign exchange
forward contract, amount utilized for cash management services, or any other extension of credit by Bank for Borrower’s benefit. 
 “Loan Documents” are, collectively, this Agreement, the IP Agreement, any Bank Services Agreements, any note, or notes or guaranties executed by Borrower or any Guarantor, and any other
present or future agreement between Borrower or any Guarantor and/or for the benefit of Bank in connection with this Agreement and/or Bank Services, all as amended, restated, or otherwise modified. 

“Prime Rate” means the greater of (i) three and one-quarter percent (3.25%) or (ii) the rate of interest
published in the “Money Rates” section of The Wall Street Journal, Eastern Edition as the “United States Prime Rate.” In the event that The Wall Street Journal, Eastern Edition is not published or such rate does not
appear in The Wall Street Journal, Eastern Edition, the Prime Rate shall be determined by Bank until such time as the Prime Rate becomes available in accordance with past practices. 

“Reserves” means, as of any date of determination, such amounts as Bank may, from time to time, reasonably establish and
revise in good faith, after consultation with Borrower and on one (1) Business Day’s notice reducing the amount of Advances, letters of credit and other financial accommodations which would otherwise be available to Borrower under the
lending formulas: (a) to reflect events, conditions, contingencies or risks which, as determined by Bank in good faith, do or may affect (i) the Collateral or any other property which is security for the Obligations or its value (including
without limitation any increase in delinquencies of Accounts), (ii) the assets or business of Borrower or any guarantor, or (iii) the security interests and other rights of Bank in the Collateral (including the enforceability, perfection
and priority thereof); or (b) to reflect 

  
 14 

 
Bank’s good faith belief that any collateral report or financial information furnished by or on behalf of Borrower or any guarantor to Bank is or may have been incomplete, inaccurate or
misleading in any material respect; or (c) in respect of any state of facts which Bank determines in good faith constitutes an Event of Default or may, with notice or passage of time or both, constitute an Event of Default. 

“Revolving Line Maturity Date” is March 28, 2014.” 

 

	 	25	The Loan Agreement shall be amended by deleting the following definitions appearing in Section 13.1 thereof: 

““Asahi Intercreditor Agreement” is that certain Intercreditor Agreement, by and between Bank and Asahi, dated as
of the date hereof, as may be amended from time to time. 
 “Asahi Term Loan” is that certain Term Loan and
Security Agreement by and among Borrower, Guarantors and Asahi, dated as of June 5, 2009, as may be amended, modified or restated from time to time. 
 “Cash Management Services” is defined in Section 2.1.4. 

“FX Business Day” is any day when (a) Bank’s Foreign Exchange Department is conducting its normal business and
(b) the Foreign Currency being purchased or sold by Borrower is available to Bank from the entity from which Bank shall buy or sell such Foreign Currency. 
 “FX Forward Contract” is defined in Section 2.1.3. 

“FX Reduction Amount” is defined in Section 2.1.3. 

“Letter of Credit” means a standby letter of credit issued by Bank or another institution based upon an application,
guarantee, indemnity or similar agreement on the part of Bank as set forth in Section 2.1.2. 
 “Letter of Credit
Application” is defined in Section 2.1.2(a). 
 “Letter of Credit Reserve” has the meaning set
forth in Section 2.1.2(d).” 
  

	 	26	The Loan Agreement shall be amended by deleting the following text appearing as clauses (h), (i) and (j) in the definition of “Permitted
Indebtedness” in Section 13.1 thereof: 

 “(h) Capital leases/equipment financing arrangements up
to the principal amount of Five Million Dollars ($5,000,000) outstanding at any time; 
 (i) Indebtedness to Asahi under the
Asahi Term Loan; 
 (j) Indebtedness incurred in connection with the Filter Plant Transactions;” 

and inserting in lieu thereof the following: 
 “(h) Capital leases/equipment financing arrangements up to the principal amount of Seven Million Five Hundred Thousand Dollars ($7,500,000) outstanding at any time; 

(i) [reserved]; 

  
 15 

 (j) Indebtedness incurred in connection with the Dialyzer Production Agreement, dated as of
June 5, 2009, as amended, by and among NxStage and Asahi Kasei Kuraray Medical Co., Inc.;” 
  

	 	27	The Loan Agreement shall be amended be deleting the following text appearing as clause (k) of the definition of “Permitted Liens” in Section 13.1
thereof: 

 “(k) Liens in favor of Ashai pursuant to the Asahi Term Loan;” 

and inserting in lieu thereof the following: 
 “(k) [reserved];” 
  

	 	28	The Compliance Certificate attached as Exhibit B to the Loan Agreement is hereby replaced with the Compliance Certificate attached as Exhibit A hereto.

 4. FEES. Borrower shall pay to Bank the following annual extension fees, which fees are fully earned as of the date
hereof: (i) Fifty Six Thousand Two Hundred Fifty Dollars ($56,250) on the date hereof; and (ii) Fifty Six Thousand Two Hundred Fifty Dollars ($56,250) on or before the date that is 364 days after the Second Loan Modification Effective
Date. Borrower shall also reimburse Bank for all legal fees and expenses incurred in connection with the Existing Loan Documents and this Second Loan Modification Agreement. 
 5. CONDITIONS PRECEDENT. Borrower hereby agrees that the following documents shall be delivered to the Bank prior to or concurrently with the effectiveness of this Loan Modification Agreement, each
in form and substance reasonably satisfactory to the Bank (collectively, the “Conditions Precedent”): 
  

	 	A.	Evidence satisfactory to Bank, in its sole discretion, that all outstanding amounts owed to Asahi by Borrower have been paid in full with proceeds from an additional
equity financing of Borrower; 

  

	 	B.	evidence that (i) the Liens securing Indebtedness owed by Borrower to Asahi will be terminated and (ii) the documents and/or filings evidencing the perfection
of such Liens, including without limitation any financing statements and/or control agreements, have or will, concurrently with the Second Loan Modification Effective Date, be terminated; 

 

	 	C.	copies, certified by a duly authorized officer of each Borrower, to be true and complete as of the date hereof, of each of (i) the governing documents of each
Borrower as in effect on the date hereof (but only to the extent modified since last delivered to the Bank), (ii) the resolutions of each Borrower authorizing the execution and delivery of this Loan Modification Agreement, the other documents
executed in connection herewith and each Borrower’s performance of all of the transactions contemplated hereby (but only to the extent required since last delivered to Bank), and (iii) an incumbency certificate giving the name and bearing
a specimen signature of each individual who shall be so authorized on behalf of each Borrower (but only to the extent any signatories have changed since such incumbency certificate was last delivered to Bank); 

 

	 	D.	Bank shall have received a certificate from the Secretary of State (or similar entity) of the applicable jurisdiction of organization of Borrower as of a recent date,
as to the Borrower’s existence and good standing in such jurisdiction; 

  

	 	E.	Bank shall have received the results of UCC searches and other searches as necessary with respect to the Collateral indicating no Liens (other than the Liens of Bank
and Permitted Liens) and otherwise in form and substance reasonably satisfactory to the Bank; 

  

	 	F.	Bank shall have received updated Property Insurance and Liability Insurance Certificates, in form and substance reasonably acceptable to Bank; and

  

	 	G.	such other documents as Bank may reasonably request. 

  
 16 

 6. CONSISTENT CHANGES. The Existing Loan Documents are hereby amended wherever necessary to reflect
the changes described above. 
 7. RATIFICATION OF LOAN DOCUMENTS. Borrower hereby ratifies, confirms, and reaffirms all terms and
conditions of the Loan Agreement (as modified hereby), each other Existing Loan Document and all security or other collateral granted to the Bank, and confirms that the indebtedness secured thereby includes, without limitation, the Obligations.
Nothing in this Loan Modification Agreement shall constitute a satisfaction of the Obligations. It is the intention of Bank and Borrower to retain as liable parties all makers of Existing Loan Documents, unless the party is expressly released by
Bank in writing. No maker will be released by virtue of this Loan Modification Agreement. 
 8. JURISDICTION/VENUE. Section 11 of
the Loan Agreement is hereby incorporated by reference in its entirety. 
 9. COUNTERSIGNATURE. This Loan Modification Agreement shall
become effective only when it shall have been executed by Borrower and Bank. 
 [Signature pages follow.] 

  
 17 

 IN WITNESS WHEREOF, the parties hereto have caused this Loan Modification Agreement to be executed as
a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first 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, Senior Vice President

and Chief Financial Officer
	 		 	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

 The undersigned, Managing Director of NxStage GmbH &Co., KG, a company organized and existing under the laws of
Germany and a wholly owned Subsidiary of Borrower, ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unconditional Guaranty dated as of March 10, 2012 (the “Guaranty”), and acknowledges,
confirms and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in
connection herewith. 
  

			
	NxStage GmbH &Co., KG
		
	By:	 	/s/ Jeffrey H. Burbank
	Name:	 	Jeffrey H. Burbank
	Title:	 	Managing Director

  
 18 

 The undersigned, Managing Director of NxStage Verwaltungs GmbH, a company organized and existing under
the laws of Germany and a wholly owned Subsidiary of Borrower, ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unconditional Guaranty dated as of March 10, 2012 (the “Guaranty”), and
acknowledges, confirms and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or
delivered in connection herewith. 
  

			
	NxStage Verwaltungs GmbH
		
	By	 	/s/ Jeffrey H. Burbank
	Name:	 	Jeffrey H. Burbank
	Title:	 	Managing Director

 The undersigned, Sole Director of Medisystems Europe S.p.A., a company organized and existing under the laws of
Italy and a wholly owned Subsidiary of Borrower, ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unconditional Guaranty dated as of March 10, 2012 (the “Guaranty”), and acknowledges, confirms
and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection
herewith. 
  

			
	Medisystems Europe S.p.A.
		
	By	 	/s/ Jeffrey H. Burbank
	Name:	 	Jeffrey H. Burbank
	Title:	 	Sole Director

 The undersigned, Chairman of Medimexico s. de R.L. de C.V., a company organized and existing under the laws of
Mexico and a wholly owned Subsidiary of Borrower, ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unconditional Guaranty dated as of March 10, 2012 (the “Guaranty”), and acknowledges, confirms
and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection
herewith. 
  

			
	Medimexico s.de R.L. de C.V.
		
	By	 	/s/ Jeffrey H. Burbank
	Name:	 	Jeffrey H. Burbank
	Title:	 	Chairman

  
 19 

 Exhibit A to Second Loan Modification Agreement 

EXHIBIT B 
 COMPLIANCE CERTIFICATE 
  

					
	TO:	 	SILICON VALLEY BANK	  	Date:                          
                          
	 FROM:
	 	 NXSTAGE MEDICAL, INC.
 EIR
MEDICAL, INC.
 MEDISYSTEMS CORPORATION

MEDISYSTEMS SERVICES CORPORATION
	  	

 The undersigned authorized officer of NXSTAGE MEDICAL, INC., EIR MEDICAL, INC., MEDISYSTEMS CORPORATION
and MEDISYSTEMS SERVICES CORPORATION (individually and collectively, jointly and severally, the “Borrower”) certifies that under the terms and conditions of the Loan and Security Agreement between Borrower and Bank (as amended from
time to time, the “Agreement”), (1) Borrower is in compliance for the period ending             with all required covenants except as noted below,
(2) there are no Events of Default, (3) all representations and warranties in the Agreement are true and correct in all material respects on this date except as noted below; provided, however, that such materiality qualifier
shall not be applicable to any representations and warranties that already are qualified or modified by materiality in the text thereof; and provided, further that those representations and warranties expressly referring to a specific
date shall be true, accurate and complete in all material respects as of such date, (4) Borrower, and each of its Subsidiaries, has timely filed all required tax returns and reports, and Borrower has timely paid all foreign, federal, state and
local taxes, assessments, deposits and contributions owed by Borrower except as otherwise permitted pursuant to the terms of Section 5.9 of the Agreement, and (5) no Liens (other than Permitted Liens) have been levied or claims made
against Borrower or any of its Subsidiaries, if any, relating to unpaid employee payroll or benefits of which Borrower has not previously provided written notification to Bank. Attached are the required documents supporting the certification. The
undersigned certifies that the monthly and quarterly financial statements are prepared in accordance with GAAP consistently applied from one period to the next except as explained in an accompanying letter or footnotes and subject to yearend
adjustments and the absence of footnotes. The undersigned acknowledges that no borrowings may be requested at any time or date of determination that Borrower is not in compliance with any of the terms of the Agreement, and that compliance is
determined not just at the date this certificate is delivered. Capitalized terms used but not otherwise defined herein shall have the meanings given them in the Agreement. 
 Please indicate compliance status by circling Yes/No under “Complies” column. 
  

					
	 Reporting Covenant
	  	 Required
	  	 Complies

			
	 Monthly consolidated and consolidating financial statements with Compliance Certificate
	  	Monthly within 30 days	  	Yes No
			
	 Quarterly consolidated financial

certificates
	  	Quarterly within 45 days	  	Yes No
			
	 Annual financial statement (CPA Audited) + CC
	  	FYE within120 days	  	Yes No
			
	 10-Q, 10-K and 8-K
	  	Within 5 days after filing with SEC	  	Yes No
			
	 A/R & A/P Agings, Deferred Revenue report, bookings

report, inventory report
	  	Monthly within 30 days, or as otherwise required	  	Yes No
			
	 Transaction Reports
	  	 Bi-weekly (Monthly within 30 days
 during a Streamline Period)
	  	Yes No
			
	 Projections
	  	FYE within 60 days	  	Yes No
	
	The following Intellectual Property was registered after the Effective Date (report on a quarterly basis) (if no registrations, state “None”)

  
 20 

											
	 Financial Covenant
	  	 Required
	 	  	 Actual
	 	  	 Complies

	 Maintain as indicated:
	  				  				  	
	 Adjusted EBITDA (tested quarterly)
	  	 
 	See Section
6.9(a)	  
  	  	 	$_______	  	  	Yes No
	 Liquidity (at all times)
	  	 	$7,500,000	  	  	 	$_______	  	  	Yes No

 The following financial covenant analyses and information set forth in Schedule 1 attached hereto are
true and accurate as of the date of this Certificate. 
 The following are the exceptions with respect to the certification
above: (If no exceptions exist, state “No exceptions to note.”) 
  

 
  

 
  

 
  

			
	 NXSTAGE MEDICAL, INC.
 EIR MEDICAL, INC.
 MEDISYSTEMS CORPORATION
 MEDISYSTEMS SERVICES CORPORATION
	  	BANK USE ONLY
	  	  
 Received by:
                                         
                   

	  	                              
      AUTHORIZED SIGNER
		  	Date:
                                         
                               
		
		  	Verified:
                                         
                           
		  	                              
      AUTHORIZED SIGNER
	By:
                                         
                        	  	
	Name:
                                         
                   	  	Date:
                                         
                               
	Title:
                                         
                     	  	
		  	Compliance Status:             Yes         No

  
 21 

 Schedule 1 to Compliance Certificate 

Financial Covenants of Borrower 
 Dated:
                                 

I. Adjusted EBITDA (Section 6.9(a)) 

Required: Adjusted EBITDA. Achieve a minimum Adjusted EBITDA, measured on a quarterly basis for each quarterly period ending date listed below, in
an amount not less than the corresponding amount listed below for such quarterly period: 
  

					
	Quarterly Period Ending	  	Minimum Adjusted EBITDA	 
	 March 31, 2012
	  	$	1.00	  
		
	 June 30, 2012
	  	$	1.00	  
		
	 September 30, 2012, and each quarterly period ending thereafter
	  	$	500,000	  

 Actual: 
  

							
			
	 A.    
	  	Net Income	  	 	$            	  
			
	 B.
	  	Interest Expense	  	 	$            	  
			
	 C.
	  	To the extent deducted in the calculation of Net Income, depreciation expense and amortization expense	  	 	$            	  
			
	 D.
	  	Income tax expense	  	 	$            	  
			
	 E.
	  	Non-cash stock compensation expenses	  	 	$            	  
			
	 F.
	  	Capital Expenditures	  	 	$            	  
			
	 G.
	  	Adjusted EBITDA (line A plus line B plus line C plus line D plus line E minus line F)	  	 	$            	  

 Is line G equal to or greater than $
[                            ]? 

 

			
	                  No, not in
compliance
	 	                 Yes, in compliance

  
 22 

	II.	Liquidity (Section 6.9(b)) 

 Required:
Maintain at all times Liquidity of at least Seven Million Five Hundred Thousand Dollars ($7,500,000). 
 Actual: 

 

							
	A.	  	Borrower’s unrestricted cash at Bank and Bank’s Affiliates	  	$	            	  
	B.	  	Availability Amount	  	$	            	  
	C.	  	LIQUIDITY (line A plus line B)	  	$	            	  

 Is line C equal to or greater than $7,500,000? 

 

			
	             No, not in compliance	  	             Yes, in compliance

 Is line C equal to or greater than $12,500,000 for Streamline Period? 

 

			
	             No, not in compliance	  	             Yes, in compliance

  
 1Subscription, Sale and Purchase Agreement

 Exhibit 10.36 
 SUBSCRIPTION, SALE AND PURCHASE AGREEMENT 
 This Subscription, Sale and
Purchase Agreement, dated as of May 4, 2012, is made and entered into by and between NxStage Medical, Inc., a Delaware corporation (the “Company”), and Asahi Kasei Medical Co., Ltd. (formerly known as Asahi Kasei Kuraray
Medical Co., Ltd.), a corporation organized and existing under the laws of Japan (the “Purchaser”). The Company and the Purchaser are collectively referred to as the “parties.” 

WHEREAS, the parties have entered into that certain Term Loan and Security Agreement dated as of June 5, 2009, as amended by
that certain Amendment to Term Loan and Security Agreement dated as of March 10, 2010 (as amended, the “Term Loan Agreement”); and 
 WHEREAS, the Company desires to prepay in full all principal and interest outstanding under its term loan pursuant to the Term Loan Agreement, without penalty, through the issuance of shares of the
Company’s common stock, $0.001 par value per share (the “Common Stock”). 
 NOW THEREFORE, in
consideration of the representations, warranties and covenants herein contained, and other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, the Company and the Purchaser agree as follows: 

1. Sale of Shares. Subject to the terms and conditions of this Agreement, at the Closing (as defined in Section 2.1 hereof)
the Purchaser agrees to purchase, and the Company agrees to issue and sell to the Purchaser, 2,456,246 shares of Common Stock (the “Shares”), representing 2,172,733 shares in payment of principal under the Term Loan Agreement and
283,513 shares in payment of interest accrued under the Term Loan Agreement through the Closing Date, of which 2,427,895 Shares are to be delivered to the Purchaser at Closing pursuant to the terms of this Agreement (the “Closing Shares”)
and 28,351 Shares representing interest being withheld by the Company shall be retained by the Company and amounts attributable thereto applied in satisfaction of the Company’s obligation to pay the Withholding Tax Amount under
Section 10.5 below. 
 2.The Closing. 
 2.1 Closing. The closing (the “Closing”) of the sale and purchase of the Shares under this Agreement will take place at the offices of the Company, 439 South Union Street, 5th
Floor, Lawrence, Massachusetts at 9:00 a.m. on May 4, 2012, or at such other time, date and place as are mutually agreed by the Company and the Purchaser. The date of the Closing is hereinafter referred to as the “Closing
Date.” 
 2.2 Transactions to be Effected at the Closing. At the Closing, (i) the Company will deliver to
the Purchaser (a) a certificate registered in the name of the Purchaser representing the Closing Shares, and (b) all other documents, instruments or certificates required to be delivered by the Company at or prior to the Closing pursuant
to this Agreement; and (ii) the Purchaser will deliver to the Company (y) as consideration for the Shares, a Cancellation Letter (as defined in Section 7.2 hereof) canceling the obligations under the Term Loan Agreement and
(z) all other documents, instruments or certificates required to be delivered by the Purchaser at or prior to the Closing pursuant to this Agreement. The Shares, as evidenced by delivery of the Closing Shares to the Purchaser and the covenant
of the Company to make payment of the Withholding Tax Amount, shall be deemed payment in full of the obligations of the Company to pay principal and interest under the Term Loan Agreement and the Note. 

 3. Representations of the Company. The Company hereby makes the following
representations and warranties to the Purchaser: 
 3.1 Subsidiaries. The only subsidiaries of the Company are those
listed on Schedule 3.1 hereto (“Subsidiaries”). Except as indicated on Schedule 3.1 hereto, the Company owns or controls, directly or indirectly, all of the capital stock or comparable equity interests of each Subsidiary free and clear of
any mortgage, lien, pledge, charge, security interest, adverse claim or other encumbrance (“Liens”). 
 3.2
Organization and Good Standing. The Company and each of its Subsidiaries (i) is an entity duly organized, validly existing and in good standing under the laws of the jurisdiction of its incorporation, (ii) has all requisite power to
own, lease and operate its properties and to carry on its business as currently conducted, and (iii) is duly qualified to do business and is in good standing as a foreign corporation in each jurisdiction in which it owns or leases property or
conducts any business so as to require such qualification, except as would not have a Material Adverse Effect. 
 3.3 Charter
and By-laws. The Company has made available to the Purchaser true, correct and complete copies of the Company’s Restated Certificate of Incorporation and By-laws, each as in effect on the date hereof. Neither the Company nor any material
Subsidiary is in violation of its certificate or articles of incorporation and bylaws or other organizational or charter documents. 
 3.4 Valid Issuance of Common Stock. When issued, sold and delivered in accordance with the terms of this Agreement in consideration for cancellation of the obligations under the Term Loan
Agreement pursuant to the Cancellation Letter in accordance with the terms of this Agreement, the Closing Shares will be duly authorized, validly issued, fully paid, non-assessable and free and clear of any Liens and restrictions on transfer other
than restrictions imposed or created under this Agreement, by applicable law or by the Purchaser and, assuming the accuracy of the representations of the Purchaser in this Agreement, will be issued in compliance in all material respects with
applicable U.S. federal securities laws. Upon sale of the Closing Shares to Purchaser in accordance with the terms of this Agreement, Purchaser will receive valid title to the Closing Shares, free and clear of all Liens. 

3.5 Capitalization. The authorized capital stock of the Company, as of April 30, 2012, consists of 100,000,000 shares of
Common Stock, of which 56,198,753 shares are issued and outstanding and 5,000,000 shares of blank check Preferred Stock, $0.001 par value per share, none of which have been designated. Options to purchase an aggregate of 5,099,093 shares of Common
Stock were outstanding as of April 30, 2012. Except as set forth herein and in the Company SEC Documents (as defined in Section 3.9 hereof), there are no outstanding rights (including conversion rights or preemptive rights and rights of
first refusal), options, warrants, instruments, or other agreements or instruments of any kind to which the Company is a party for the purchase or acquisition from the Company of any securities of the Company. 

  
 2 

 3.6 No Conflicts. The execution, delivery and performance of this Agreement and the
Registration Rights Agreement by the Company and the consummation by the Company of the transactions contemplated hereby and thereby do not, and will not, (i) conflict with or violate any provision of the Company’s or any Subsidiary’s
certificate or articles of incorporation, bylaws or other organizational or charter documents, (ii) conflict with, or constitute a default (or an event that with notice or lapse of time or both would become a default) under, or give to others
any rights of termination, amendment, acceleration or cancellation (with or without notice, lapse of time or both) of, any agreement, credit facility, debt or other instrument (evidencing a Company or Subsidiary debt or otherwise) or other similar
understanding to which the Company or any Subsidiary is a party or by which any property or asset of the Company or any Subsidiary is bound, or affected, except to the extent that such conflict, default, termination, amendment, acceleration or
cancellation right would not reasonably be expected to have a material adverse effect on the results of operations, assets, business, or financial condition of the Company and the Subsidiaries taken as a whole on a consolidated basis or materially
and adversely impair the Company’s ability to perform its obligations under this Agreement or the Registration Rights Agreement (a “Material Adverse Effect”), or (iii) result in a violation of any law, rule, regulation, order,
judgment, injunction, decree or other restriction of any court or governmental authority to which the Company or any Subsidiary is subject, or by which any property or asset of the Company or any Subsidiary are bound or affected, except to the
extent that such violation would not reasonably be expected to have a Material Adverse Effect. 
 3.7 No Consents. No
authorization or order of, registration, declaration or filing with, or notice to, any governmental entity or other person is required by or with respect to the Company or any of its Subsidiaries in connection with the execution and delivery of this
Agreement and the consummation of the transactions contemplated hereby, except for such filings as may be required under the antitrust and competition laws of all jurisdictions other than those of the United States, and as may be required by the
NASDAQ Stock Market. 
 3.8 Compliance. Except as would not, individually or in the aggregate, reasonably be expected to
have or result in a Material Adverse Effect, (i) neither the Company nor any Subsidiary is in default under or in violation of (and no event has occurred that has not been waived that, with notice or lapse of time or both, would result in a
default by the Company or any Subsidiary under), nor has the Company or any Subsidiary received written notice of a claim that it is in default under or that it is in violation of, any indenture, loan or credit agreement or any other material
agreement to which it is a party or by which it or any of its properties is bound (whether or not such default or violation has been waived), (ii) neither the Company nor any Subsidiary is in violation of any order of any court, arbitrator or
governmental body, or (iii) to the knowledge of the executive officers of the Company (which, for the avoidance of doubt, includes the functional heads of the Company responsible for regulatory, quality, intellectual property and legal matters,
the “Executive Officers”), neither the Company nor any Subsidiary is in violation of any statute, rule or regulation of any governmental authority. 
 3.9 Financial Statements and SEC Filings. Since January 1, 2012, the Company has filed all reports, schedules, forms, financial statements and other documents (including exhibits and
all other information incorporated therein) required to be filed with the 

  
 3 

 
Securities and Exchange Commission (the “SEC”) by it under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), including pursuant to Section 13(a) or
15(d) thereof (the “Company SEC Documents”) on a timely basis or has received a valid extension of such time of filing and has filed any such Company SEC Documents prior to the expiration of any such extension and has filed all
reports required to be filed by it under the Exchange Act, including pursuant to Section 13(a) or 15(d) thereof, for the two years preceding the date hereof. As of their respective dates, the Company SEC Documents complied as to form in all
material respects with the requirements of the Securities Act of 1933, as amended (the “Securities Act”) or the Exchange Act, as the case may be, and the rules and regulations of the SEC promulgated thereunder applicable to such
Company SEC Documents. At the time they were filed with the SEC, the Company SEC Documents did not contain any untrue statement of a material fact or omit to state a material fact required to be stated therein or necessary in order to make the
statements therein, in the light of the circumstances under which they were made, not misleading. As of their respective dates, the financial statements of the Company included in the Company SEC Documents, as amended, complied as to form in all
material respects with applicable accounting requirements and the published rules and regulations of the SEC with respect thereto. Such financial statements have been prepared in accordance with United States generally accepted accounting
principles, consistently applied, during the periods involved (except as may be otherwise indicated in such financial statements or the notes thereto) and fairly presented in all material respects the financial position of the Company as of the
dates thereof and the results of its operations and cash flows for the periods then ended (subject, in the case of unaudited statements, to normal year-end audit adjustments). 
 3.10 NASDAQ Listing. As of the date hereof, the Common Stock is listed on the NASDAQ Global Select Market, the Company has not, in the twelve months preceding the date hereof, received notice
(written or oral) from the NASDAQ Global Select Market to the effect that the Company is not in compliance with the listing or maintenance requirements of the NASDAQ Global Select Market and the Company has not received any notification that the
NASDAQ Global Select Market is contemplating terminating such listing. The Company is in compliance with all such listing and maintenance requirements. 
 3.11 Registration Rights. Other than pursuant to the Registration Rights Agreement or as set forth on Schedule 3.11 hereto, the Company has not granted or agreed to grant to any Person any rights
(including “piggy-back” registration rights) to have any securities of the Company registered with the SEC or any other governmental authority that have not expired or been satisfied or waived. 

3.12 No Material Adverse Change; Undisclosed Events, Liabilities or Developments; Solvency. Since the date of the latest audited
financial statements included within the Company SEC Documents, except as disclosed in the Company SEC Documents, (i) there has been no event, occurrence or development that, individually or in the aggregate, has had, or that would reasonably
be expected to result in, a Material Adverse Effect, (ii) the Company has not declared or made any dividend or distribution of cash or other property to its stockholders, in their capacities as such, or purchased, redeemed or made any
agreements to purchase or redeem any shares of its capital stock, and (iii) the Company has not issued any equity securities to any officer, director or affiliate, except pursuant to existing Company stock-based 

  
 4 

 
plans, (iv) the Company has not incurred any material liabilities other than (A) trade payables and accrued expenses incurred in the ordinary course of business consistent with past
practice and (B) liabilities not required to be reflected in the Company’s financial statements pursuant to United States generally accepted accounting principles or required to be disclosed in filings made with the SEC, and (v) the
Company has not altered its method of accounting or changed its auditors. The Company has not taken any steps to seek protection pursuant to any bankruptcy law nor do the Executive Officers have any knowledge or reason to believe that its creditors
intend to initiate involuntary bankruptcy proceedings or any actual knowledge of any fact which would reasonably lead a creditor to do so. The Company is not as of the date hereof, and after giving effect to the transactions contemplated hereby to
occur at the applicable Closing, will not be Insolvent (as defined below). For purposes of this Section 3.12, “Insolvent” means (i) the present fair saleable value of the Company’s assets is less than the amount required to
pay the Company’s total Indebtedness (as defined in Section 3.13 hereof), (ii) the Company is unable to pay its debts and liabilities, subordinated, contingent or otherwise, as such debts and liabilities become due and payable,
(iii) the Company intends to incur or believes that it will incur debts that would be beyond its ability to pay as such debts become due and payable or (iv) the Company has unreasonably small capital with which to conduct the business in
which it is engaged as such business is now conducted and is proposed to be conducted. 
 3.13 Corporate Power/Authorization;
Enforcement. The Company has the requisite corporate authority to enter into and to consummate the transactions contemplated by this Agreement and the Registration Rights Agreement (as defined in Section 6.5 hereof) and otherwise to carry
out its obligations hereunder and thereunder. The execution and delivery of this Agreement and the Registration Rights Agreement by the Company and the consummation by it of the transactions contemplated hereby and thereby have been duly authorized
by all necessary corporate action on the part of the Company and no further consent or action is required by the Company, its Board of Directors or its stockholders. This Agreement and the Registration Rights Agreement have been (or upon delivery
will be) duly executed by the Company and are, or when delivered in accordance with the terms hereof, will constitute, the valid and binding obligation of the Company enforceable against the Company in accordance with their terms. 

3.14 Form S-3 Eligibility. As of the date hereof, the Company has a shelf Registration Statement on Form S-3 that has been
declared effective by the United States Securities and Exchange Commission, and with the filing of a suitable prospectus supplement the Closing Shares can be made eligible for resale by the Purchaser using such Form S-3. 

3.15 No General Solicitation. Neither the Company nor any person acting on its behalf have engaged in any form of general
solicitation or general advertising (within the meaning of Regulation D) in connection with the offer or sale of the Shares. 

3.16 Brokers’ Fees. The Company has no liability or obligations to pay any fees or commissions to any broker, finder or agent
with respect to the transactions contemplated by this Agreement. 

  
 5 

 3.17 Private Placement; Investment Company; Real Property Holding Corporation.
Neither the Company nor any of its affiliates nor, any Person acting on the Company’s behalf has, directly or indirectly, at any time within the past six months, made any offer or sale of any security or solicitation of any offer to buy any
security under circumstances that would (i) eliminate the availability of the exemption from registration under Regulation D under the Securities Act in connection with the offer and sale by the Company of the Shares as contemplated hereby or
(ii) cause the offering of the Shares pursuant to this Agreement to be integrated with prior offerings by the Company for purposes of any applicable law, regulation or stockholder approval provisions, including, without limitation, under the
rules and regulations of the NASDAQ Global Select Market. Assuming the accuracy of the representations and warranties of the Purchaser set forth in Section 4, no registration under the Securities Act is required for the offer and sale of the
Shares by the Company to the Purchaser as contemplated hereby. Assuming the accuracy of the representations and warranties of the Purchaser set forth in Section 4, the sale and issuance of the Shares hereunder does not contravene the rules and
regulations of the NASDAQ Global Select Market. The Company is not and, after giving effect to the offering and sale of the Shares to be sold by the Company hereunder and the application of the proceeds thereof, will not be an “investment
company”, as such term is defined in the Investment Company Act of 1940, as amended. The Company is not required to be registered as a United States real property holding corporation within the meaning of the Foreign Investment in Real Property
Tax Act of 1980. 
 3.18 Sarbanes-Oxley Act. The Company is in material compliance with applicable requirements of the
Sarbanes-Oxley Act of 2002 that are effective as of the date hereof, and applicable rules and regulations promulgated by the SEC thereunder that are effective as of the date hereof. 

3.19 Absence of Litigation. Except for the Gambro litigation specifically identified in the Legal Proceedings items of the Company
SEC Documents, there is no action, suit or proceeding, or governmental inquiry or investigation or proceeding, pending, or, to the best knowledge of the Executive Officers, any basis therefor or threat thereof, against the Company or any subsidiary
of the Company, which would be reasonably likely to have a Material Adverse Effect. For the avoidance of doubt, the identification the Gambro litigation as an exception to the foregoing sentence by virtue of it being identified in the Legal
Proceedings item of a Company SEC Document, shall not be deemed an admission that such matter is material to the Company or that it would be reasonably likely to have a Material Adverse Effect. 

3.20 Property. The Company and its Subsidiaries have good and marketable title in fee simple to all real property and good and
marketable title to all personal property owned by them, in each case free and clear of Liens and defects except such as are described in the Company SEC Documents or such as do not materially affect the value of such property and do not materially
interfere with the use made and proposed to be made of such property by the Company and its Subsidiaries. Any real property, buildings and vehicles held under lease by the Company and its subsidiaries are held by them under valid, subsisting and
enforceable leases with such exceptions as are not material and do not materially interfere with the use made and proposed to be made of such property, buildings and vehicles by the Company and its Subsidiaries. 

  
 6 

 3.21Environmental Laws. Except as would not reasonably be expected to have,
individually or in the aggregate, a Material Adverse Effect, the Company and each Subsidiary (i) is in compliance in all material respects with any and all Environmental Laws (as hereinafter defined), (ii) has received all permits,
licenses or other approvals required of them under applicable Environmental Laws to conduct their respective businesses and (iii) is in compliance in all material respects with all terms and conditions of any such permit, license or
approval. The term “Environmental Laws” means all federal, state, local or foreign laws relating to pollution or protection of human health or the environment (including, without limitation, ambient air, surface water, groundwater,
land surface or subsurface strata), including, without limitation, laws relating to emissions, discharges, releases or threatened releases of chemicals, pollutants, contaminants, or toxic or hazardous substances or wastes (collectively,
“Hazardous Materials”) into the environment, or otherwise relating to the manufacture, processing, distribution, use, treatment, storage, disposal, transport or handling of Hazardous Materials, as well as all authorizations, codes,
decrees, demands or demand letters, injunctions, judgments, licenses, notices or notice letters, orders, permits, plans or regulations issued, entered, promulgated or approved thereunder, in each case having the effect or force of law. 

3.22 Intellectual Property Rights. Except as described in the Company SEC Documents or except where the failure of any of the
following representations to be true would not reasonably be expected to have a Material Adverse Effect: (i) to the knowledge of the Executive Officers, the Company and its Subsidiaries own, possess, or have valid, binding and enforceable
licenses or other rights to use the patents, patent rights and patent applications, copyrights, trademarks, service marks, trade names, Internet domain names, technology, confidential information, software, know-how, including (trade secrets and
other unpatented and/or unpatentable proprietary or confidential information, systems or procedures) and other intellectual property and proprietary rights necessary or used in connection with the conduct of their business as currently conducted
(but not including any projects currently in development) and in the manner set forth in the Company SEC Documents (collectively, the “Company Intellectual Property”); (ii) to the knowledge of the Executive Officers, none of the
Company Intellectual Property owned by the Company or its Subsidiaries is invalid or unenforceable and neither the Company nor any of its Subsidiaries has received any challenge (including without limitation, notices of expiration) to the validity
or enforceability thereof from any third party or governmental authority and the Company and its Subsidiaries have made all filings and paid all fees necessary to maintain any Company Intellectual Property owned by any of them; (iii) the
Company and its Subsidiaries have taken reasonable measures necessary to secure their interests in Company Intellectual Property, including the confidentiality of all trade secrets and confidential information which constitutes Company Intellectual
Property, and to secure assignment of Company Intellectual Property from its employees and contractors; (iv) the Company is not aware of any Company Intellectual Property required to be described in the Company SEC Documents which is not so
described; (v) neither the Company nor any of its Subsidiaries has received any notice of a claim of infringement or misappropriation of (and the Company does not know of any infringement or misappropriation of) intellectual property rights of
others by the Company or any of its Subsidiaries; (vi) to the knowledge of the Executive Officers, it and its Subsidiaries are not in breach of, and have complied with all terms of, any license or other agreement relating to any Company
Intellectual Property, and no party to any such agreement has given the Company or its Subsidiaries notice of its intention to cancel, 

  
 7 

 
terminate, alter the scope of rights under or fail to renew any such agreement; and (vii) the Company is not aware of any suit or other proceeding pending against the Company or any of its
Subsidiaries concerning any agreement concerning the Company Intellectual Property, including any proceeding concerning a claim that the Company or its Subsidiaries or another person has breached any such agreement. 

3.23 Regulatory Permits. The Company and each Subsidiary possesses all certificates, authorizations and permits issued by the
appropriate federal, state, local or foreign regulatory authorities necessary to conduct their respective businesses as presently conducted and described in the Company SEC Documents (“Material Permits”), except where the failure to
possess such permits does not have, or would not reasonably be expected to result in, individually or in the aggregate, a Material Adverse Effect, and neither the Company nor any Subsidiary has received any written notice of proceedings relating to
the revocation or modification of any Material Permit. 
 3.24 Insurance. The Company and each Subsidiary is insured by
insurers of recognized financial responsibility against such losses and risks and in such amounts as are prudent and customary in the businesses and locations in which the Company and each Subsidiary is engaged. 

3.25 Internal Accounting and Disclosure Controls. The Company maintains accurate books and records reflecting its assets and
liabilities and maintains proper and adequate control over financial reporting to provide reasonable assurance that (i) transactions are executed in accordance with management’s general or specific authorization, (ii) transactions are
recorded as necessary to permit preparation of the financial statements of the Company and to maintain accountability for the assets of the Company, (iii) access to the assets of the Company is permitted only in accordance with
management’s general or specific authorization, (iv) the reporting of the assets of the Company is compared with the existing assets of the Company at reasonable intervals and (v) accounts, notes and other receivables and inventory
were recorded accurately, and proper and adequate procedures are implemented to effect the collection thereof on a current and timely basis. The Company maintains a system of internal control over financial reporting (as such term is defined in Rule
13a-15(f) under the Exchange Act) that complies with the requirements of the Exchange Act and has been designed by the Company’s principal executive officer and principal financial officer, or under their supervision, to provide reasonable
assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with United States generally accepted accounting principles. The Company’s internal control over
financial reporting is effective and the Company is not aware of any material weaknesses in its internal control over financial reporting. Since the date of the latest audited financial statements included in the Company SEC Documents, there has
been no change in the Company’s internal control over financial reporting that has materially adversely affected, or is reasonably likely to materially adversely affect, the Company’s internal control over financial reporting. The Company
maintains disclosure controls and procedures (as such term is defined in Rule 13a-15(e) under the 1934 Act) that are effective in ensuring that information required to be disclosed by the Company in the reports that it files or submits under the
Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the rules and forms of the SEC, including, without limitation, controls and 

  
 8 

 
procedures designed to ensure that information required to be disclosed by Company in the reports that it files or submits under the Exchange Act is accumulated and communicated to Company’s
management, including its principal executive officer or officers and its principal financial officer or officers, as appropriate, to allow timely decisions regarding required disclosure. 

3.26 Tax Status. The Company and each Subsidiary (i) has made or filed all material foreign, federal and state income and all
other material tax returns, reports and declarations required by any jurisdiction to which it is subject, subject to any available extension, (ii) has paid all taxes and other governmental assessments and charges that are material in amount,
shown or determined to be due on such returns, reports and declarations, except those being contested in good faith and (iii) has set aside on its books provision reasonably adequate for the payment of all taxes for periods subsequent to the
periods to which such returns, reports or declarations apply. There are no unpaid taxes in any material amount claimed to be due by the taxing authority of any jurisdiction, and the officers of the Company know of no basis for any such claim.

 3.27 Product Regulatory Matters 
 (a) The Company has complied and is complying, in each case in all material respects, with all applicable laws with respect to the conduct of its business, and the products that it tests, manufactures,
packages, labels, markets, sells, or distributes (“Products”), including, without limitation: (i) the Federal Food, Drug, and Cosmetic Act and comparable laws in other countries applicable to the Products; (ii) any applicable
Food and Drug Administration (“FDA”) investigational device exemption, premarket approval or 510(k) clearance; (iii) relevant state laws and regulations; and (v) the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), the Civil
Monetary Penalty Statute (42 U.S.C. § 1320a-7a), the False Claims Act (31 U.S.C. § 3729 et seq.), and all of the regulations promulgated under all such statutes. 
 (b) Except as disclosed in the Company SEC Documents, there are not presently pending, nor, to knowledge of the Executive Officers, threatened, any material civil, criminal or administrative actions,
suits, demands, claims, hearings, notices of violation, investigations, proceedings, demand letters, or other communications relating to any alleged hazard or alleged defect in design, manufacture, materials or workmanship, including, without
limitation, any failure to warn or alleged breach of express or implied warranty or representation, relating to any Product, or alleging that any Product is otherwise unsafe or ineffective for its intended use. 

(c) Except as previously disclosed to the Purchaser by the Company, there have been no Recalls (as hereinafter defined) since
January 1, 2007. The term “Recall” means the voluntary or mandated removal or correction of a Product marketed by the Company that qualifies as a Class I or Class II recall, as those terms are defined under 21 C.F.R. § 7.3, or is
required to be reported to the FDA under 21 C.F.R. § 806.10. 

  
 9 

 3.28 Anti-corruption; Money Laundering. 

(a) Neither the Company nor any of its Subsidiaries, nor, to the knowledge of the Executive Officers , any other person associated with
or acting on behalf of the Company or any of its subsidiaries, including, without limitation, any director, officer, agent or employee of the Company or any of its subsidiaries, has, while acting on behalf of the Company or any of its subsidiaries,
(A) used any corporate funds for unlawful contributions, gifts, entertainment or other unlawful expenses relating to political activity; (B) made any direct or indirect unlawful payment to foreign or domestic government officials or
employees from corporate funds; (C) made any bribe, rebate, payoff, influence payment, kickback or other unlawful payment; or (D) taken any action that would result in a violation by such persons of any provision of the Foreign Corrupt
Practices Act of 1977, as amended, and the rules and regulations thereunder; and the Company has instituted and maintains policies and procedures reasonably designed to ensure compliance therewith. 

(b) None of the Company, any of its Subsidiaries or, to the knowledge of the Executive Officers, any director, officer, agent, affiliate
or employee of the Company or any of its Subsidiaries is currently subject to any sanctions administered by the Office of Foreign Assets Control of the U.S. Treasury Department (“OFAC”); and the Company will not directly or indirectly use
the proceeds from the sale of the Shares by the Company, or lend, contribute or otherwise make available such proceeds to any subsidiary, affiliate, joint venture partner or other person or entity for the purpose of financing the activities of any
person currently subject to any sanctions administered by OFAC. 
 4. Representations of the Purchaser. The Purchaser
represents and warrants to the Company as follows: 
 4.1 Corporate Power/Authorization. The Purchaser has all requisite
corporate power and authority and has taken all necessary corporate action to execute and deliver this Agreement and perform its obligations hereunder. This Agreement constitutes the valid and binding obligation of the Purchaser, enforceable in
accordance with its terms. 
 4.2 No Current Ownership in the Company. The Purchaser does not own of record or
beneficially own (as defined in Rule 13d-3 of the Exchange Act) any voting securities of the Company, or any securities convertible or exercisable for any such voting securities. 

4.3 Purchase Entirely for Own Account. The Purchaser is acquiring the Shares for investment for its own account, not as a
nominee or agent, and not with a view to the resale or distribution of any part thereof, and it has no present intention of selling, granting any participation in, or otherwise distributing any of the Shares. The Purchaser has no current agreement,
arrangement, undertaking, obligation or commitment providing for the disposition of the Shares and has not been organized, reorganized or recapitalized specifically for the purpose of acquiring the Shares. 

4.4 Disclosure of Information. The Purchaser has received all the information that it considers necessary or appropriate for
deciding whether to enter into this Agreement and to acquire the Shares. The Purchaser has had an opportunity to ask questions and receive answers from the Company regarding the terms and conditions of the offering of the Shares. 

  
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 4.5 Investment Experience. The Purchaser acknowledges that it can bear the
economic risk of its investment and has such knowledge and experience in financial or business matters that it is capable of evaluating the merits and risks of the investment in the Shares. 

4.6 Accredited Investor. The Purchaser is an “accredited investor” as such term is defined in Rule 501(a) under the
Securities Act. 
 4.7 Shares Not Registered. The Purchaser understands that the Shares have not been registered under
the Securities Act, by reason of their issuance by the Company in a transaction exempt from the registration requirements of the Securities Act, and that the Closing Shares must continue to be held by the Purchaser unless a subsequent disposition
thereof is registered under the Securities Act or is exempt from such registration. The Purchaser understands that the exemptions from registration afforded by Rule 144 (the provisions of which are known to it) promulgated under the Securities Act
depend on the satisfaction of various conditions. 
 4.8 Brokers’ Fees. The Purchaser has no liability or
obligation to pay any fees or commissions to any broker, finder or agent with respect to the transactions contemplated by this Agreement. 
 4.9 Foreign Investor. The Purchaser has satisfied itself as to the full observance of the laws of Japan in connection with any invitation to subscribe for the Shares or any use of this
Agreement, including (i) the legal requirements of Japan for the purchase of the Shares, (ii) any Japanese foreign exchange restrictions applicable to such purchase, and (iii) any Japanese governmental or other consents that may need
to be obtained. The Purchaser’s subscription and payment for and purchase of the Shares does not violate any applicable securities or other laws of Japan. 
 5. Conditions to the Obligations of the Company and the Purchaser. The respective obligations of the Company and the Purchaser to consummate the transactions contemplated by this Agreement at the
Closing are subject to the satisfaction of the following condition: 
 5.1 Qualifications. All authorizations, approvals
or permits, if any, of any governmental entity that are required as of the Closing Date in connection with the issuance and sale of the Shares to the Purchaser pursuant to this Agreement shall be duly obtained and effective as of the Closing Date.

 5.2 No Governmental Proceedings. No proceeding challenging this Agreement or the transactions contemplated hereby, or
seeking to prohibit, alter, prevent or materially delay the Closing, shall have been instituted before any governmental entity and shall be pending. 
 6. Conditions to the Obligations of the Purchaser. The obligation of the Purchaser to purchase the Shares at the Closing is subject to the fulfillment, or the waiver by the Purchaser, of
each of the following conditions on or before the Closing: 

  
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 6.1 Accuracy of Representations and Warranties. Each representation and
warranty contained in Section 3 shall be true and correct on and as of the Closing Date with the same effect as though such representation and warranty had been made on and as of that date. 

6.2 Performance. The Company shall have performed, satisfied and complied in all material respects with all covenants, agreements
and conditions required under this Agreement to be performed, satisfied or complied with by it at or prior to the Closing. 

6.3 No Material Adverse Change. There shall have been no material adverse change in the condition (financial or otherwise),
operations, results of operations or prospects of the Company and its Subsidiaries taken as a whole. 
 6.4 No Suspensions of
Trading on Common Stock; Listing. Trading in the Common Stock shall not have been suspended by the SEC or the NASDAQ Global Select Market (except for any suspensions of trading of not more than one trading day solely to permit dissemination of
material information regarding the Company) at any time since the date of execution of this Agreement, and the Common Stock shall have been at all times since such date listed for trading on the NASDAQ Global Select Market. 

6.5 Registration Rights Agreement. The Company shall have entered into a registration rights agreement, substantially in the form
attached hereto as Exhibit A (the “Registration Rights Agreement”), pursuant to which the Company has agreed to provide certain registration rights under the Securities Act with respect to the Closing Shares. 

6.6 Secretary’s Certificate. The Company shall have delivered to the Purchaser a certificate of the Secretary of the Company
dated the Closing Date and certifying that attached thereto are true and complete copies of all resolutions adopted by the Board of Directors of the Company authorizing the execution, delivery and performance of this Agreement and the Registration
Rights Agreement and the consummation of the transactions contemplated hereunder and thereunder, and that all such resolutions are in full force and effect and there are no actions of the Board of Directors amending, modifying, rescinding, revoking
or limiting such resolutions. 
 6.7 Opinion. The Purchaser shall have received the opinion of Hogan Lovells US LLP,
dated as of the Closing Date, in form and substance reasonably satisfactory to the Purchaser. 
 7. Conditions to the
Obligations of the Company. The obligations of the Company under Section 1 of this Agreement are subject to fulfillment of the following conditions on or before the Closing: 

7.1 Accuracy of Representations and Warranties. The representations and warranties of the Purchaser contained in Section 4
shall be true and correct on and as of the Closing Date with the same effect as though such representations and warranties had been made on and as of that date. 

  
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 7.2 Loan Repayment. Concurrently with the delivery of the Closing Shares to the
Purchaser, the Purchaser shall deliver to the Company, in a form reasonably satisfactory to the Company, (a) appropriately completed UCC termination statements terminating all financing statements naming the Purchaser as secured party and which
cover any property of the Borrowers, (b) the original Note stamped cancelled, as well as any collateral in the possession of Purchaser as security pursuant to the Term Loan Agreement, and (c) a written agreement (the “Cancellation
Letter”) pursuant to which the Purchaser will (i) acknowledge (A) receipt of the Shares, (B) that the Obligations of the Borrowers have been satisfied in full and the Borrowers are fully released from any further Obligations,
(C) that all Liens and other security interests created pursuant to the Term Loan Agreement or any other Security Document (“Purchaser Liens”) are fully released and discharged, (D) that the Guarantee Obligations have been
satisfied in full and the Guarantors are fully released from any further Guarantee Obligations, and (E) that the Financing Documents and Security Documents are terminated and of no further force or effect (except for Section 2.5 and
Section 10 of the Term Loan Agreement, which shall survive), (ii) covenant and agree that the Purchaser will (A) deliver to the Company such other Lien release documents as the Company may deem necessary or useful to terminate (or
terminate of record) all Purchaser Liens, and (B) take all such further actions and execute, acknowledge and deliver all such further documents as the Company may deem necessary or useful in carrying out the foregoing purposes, and
(iii) authorize the Company to file UCC termination statements relating to any Purchaser Liens should the Purchaser fail to promptly do so. Capitalized terms used in this Section 7.2 and not otherwise defined in this Agreement shall have
the meaning set forth in the Term Loan Agreement. 
 8. Limitations on Transfer and Trading. 

8.1 Restricted Shares. “Restricted Shares” means (a) the Closing Shares and (b) any other shares of
capital stock of the Company issued in respect of such shares (as a result of stock splits, stock dividends, reclassifications, recapitalizations or similar events); provided, however, that shares of Common Stock which are Restricted Shares shall
cease to be Restricted Shares (x) upon any sale pursuant to an effective registration statement under the Securities Act or Rule 144 under the Securities Act or (y) at such time as they become eligible for sale under Rule 144(b)(1) under
the Securities Act. 
 8.2 Requirements for Transfer. The Purchaser acknowledges and agrees that the Restricted Shares
shall not be sold or transferred unless either (a) they first shall have been registered under the Securities Act or (b) the Company first shall have been furnished with an opinion of legal counsel, reasonably satisfactory to the Company,
to the effect that such sale or transfer is exempt from the registration requirements of the Securities Act. 
 8.3
Legend. Each certificate representing Restricted Shares shall bear a legend substantially in the following form: 
 “The shares represented by this certificate have not been registered under the Securities Act of 1933, as amended, and may not be offered, sold or otherwise transferred, pledged or hypothecated
unless and until such shares are registered under such Securities Act or an opinion of counsel satisfactory to the Company is obtained to the effect that such registration is not required.” 

  
 13 

 The Purchaser acknowledges and agrees that the Company, in its discretion, may cause stop
transfer orders to be placed with its transfer agent with respect to the certificates representing any Restricted Shares in order to facilitate the transfer restrictions referred to in Section 8.2. The Company shall remove the legend from the
certificates representing any Restricted Shares, at the request of the holder thereof, at such time as they become eligible for resale pursuant to Rule 144(b)(1) under the Securities Act; are sold pursuant to Rule 144; or are sold pursuant to an
effective registration statement under the Securities Act. 
 9. [Intentionally omitted]. 

10. Additional Covenants 
 10.1 Furnishing of Information. Until the date that the Purchaser may sell all of its Closing Shares under Rule 144 of the Securities Act (or any successor provision), the Company covenants to use
its commercially reasonable efforts to timely file (or obtain extensions in respect thereof and file within the applicable grace period) all reports required to be filed by the Company after the date hereof pursuant to the Exchange Act. 

10.2 Integration. The Company shall not, and shall use its commercially reasonable efforts to ensure that no affiliate thereof
shall, sell, offer for sale or solicit offers to buy or otherwise negotiate in respect of any security (as defined in Section 2 of the Securities Act) that would be integrated with the offer or sale of the Shares in a manner that would require
the registration under the Securities Act of the sale of the Shares to the Purchaser or that would be integrated with the offer or sale of the Shares for purposes of the rules and regulations of the NASDAQ Global Select Market. 

10.3 Listing Requirements. As soon as reasonably practical following the Closing, the Company shall take all actions necessary to
ensure that the Common Stock issued pursuant to this Agreement is listed on the NASDAQ Global Select Market. 
 10.4 Public
Announcement. Each of the Purchaser and the Company will hold the existence, terms and conditions of the transactions contemplated by this Agreement in confidence and not to disclose the same to any other person until such time as the Company
publicly announces the offering, which will be pursuant to a press release to be mutually agreed upon by the parties. 
 10.5
Withholding Tax Amount. The Company shall timely pay an amount in cash equal to $521,948 on account of required U.S. withholding tax with respect to accrued and unpaid interest on the Note (the “Withholding Tax Amount”) to the
United States Treasury in accordance with the Internal Revenue Code of 1986, as amended (the “Code”). The Company shall deliver to the Purchaser the original or a certified copy of the receipt issued by the U.S. Treasury evidencing
such payment, a copy of any return required by the Code to report such payment or other evidence of such payment reasonably satisfactory to the Purchaser. 

  
 14 

 11. Miscellaneous. 

11.1 Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the Company and the Purchaser and
their respective successors and permitted assigns. Neither party may assign this Agreement without the prior written consent of the other party, except that the Purchaser is permitted to transfer any Common Stock owned by it or this Agreement, the
Registration Rights Agreement and any other related agreements, and any or all of its right, title and interest therein, to any of its majority owned subsidiaries, in whole or in part, and any such transferee shall have all rights and privileges of
the Purchaser so transferred under such agreements or in respect of such Common Stock. 
 11.2 Survival. All
representations and warranties of the Company in this Agreement and in any certificates delivered by the Company at Closing shall survive until the Closing, other than the representations and warranties contained in Sections 3.4 and 3.5, which shall
survive indefinitely. 
 11.3 Severability. The invalidity or unenforceability of any provision of this Agreement shall
not affect the validity or enforceability of any other provision of this Agreement. 
 11.4 Specific Performance. In
addition to any and all other remedies that may be available at law in the event of any breach of this Agreement, each party shall be entitled to specific performance of the agreements and obligations of the other party hereunder and to such other
injunctive or other equitable relief as may be granted by a court of competent jurisdiction. 
 11.5 Governing Law. This
Agreement shall be governed by and construed in accordance with the laws of the State of New York, without regard to conflicts of laws principles. 
 11.6 Notices. All notices, requests, consents and other communications under this Agreement shall be in writing and shall be deemed delivered (a) two business days after being sent by
registered or certified mail, return receipt requested, postage prepaid or (b) one business day after being sent via a reputable nationwide overnight courier service guaranteeing next business day delivery, in each case to the intended
recipient as set forth below: 
 If to the Company, at 439 South Union Street, 5th Floor, Lawrence, MA 01843, Attention: President, with a copy to the
General Counsel, or at such other address or addresses as may have been furnished in writing by the Company to the Purchaser, with copies to Michael Silver and William Intner, Hogan Lovells US LLP, 100 International Drive, Baltimore, MD 21202; and

 If to the Purchaser, at 1-105, Kanda Jinbocho, Chiyoda-ku Tokyo 101-8101, Japan, Attention: President, with a
copy to the General Manager, Corporate Planning and Coordination Division, and an additional copy to the General Manager, Legal Division, or at such other address or addresses as may have been furnished in writing by the Purchaser to the Company,
with a copy to Alan J. Neuwirth and Bradley K. Edmister, Morgan, Lewis & Bockius LLP, 101 Park Avenue, New York, NY 10178. 

  
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 Either party may give any notice, request, consent or other communication under this
Agreement using any other means (including, without limitation, personal delivery, messenger service, telecopy, first class mail or electronic mail), but no such notice, request, consent or other communication shall be deemed to have been duly given
unless and until it is actually received by the other party. Either party may change the address to which notices, requests, consents or other communications hereunder are to be delivered by giving the other party notice in the manner set forth in
this Section 11.6. 
 11.7 Indemnification. Each party agrees to indemnify and to hold harmless the other party from any
liability for any commission or compensation in the nature of a finder’s or broker’s fee arising out of this transaction (and the costs and expenses of defending against such liability or asserted liability) for which the indemnifying
party or any of its officers, employees, or representatives is responsible. 
 11.8 Complete Agreement. This Agreement
constitutes the entire agreement and understanding of the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings relating to such subject matter. 

11.9 Amendments and Waivers. Except as otherwise expressly set forth in this Agreement, any term of this Agreement may be amended
or terminated and the observance of any term of this Agreement may be waived (either generally or in a particular instance and either retroactively or prospectively), with the written consent of the Company and the Purchaser. 

11.10 Counterparts; Facsimile Signatures. This Agreement may be executed in any number of counterparts, each of which shall be
deemed to be an original, and all of which shall constitute one and the same document. The delivery of a signature page of this Agreement by one party to the other party via facsimile transmission shall constitute the execution and delivery of this
Agreement by the transmitting party. 
 11.11 Section Headings. The section headings are for the convenience of the
parties and in no way alter, modify, amend, limit or restrict the contractual obligations of the parties. 
 11.12 Legal Fees
and Expenses. Each of the parties to this Agreement will bear its own legal fees and other expenses with respect to the negotiation of and entry into this Agreement and the transactions contemplated by this Agreement. The Company shall pay all
transfer agent fees, stamp taxes and other taxes and duties levied by any United States Federal, State or local governmental entity in connection with the sale and issuance of the Shares. 

[Remainder of page intentionally left blank] 

  
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 Executed as of the date first written above. 

 

			
	THE COMPANY:
	
	NXSTAGE MEDICAL, INC.
		
	By:	 	/s/ Jeffrey H. Burbank
		 	Name: Jeffrey H. Burbank
		 	Title: Chief Executive Officer
	
	THE PURCHASER:
	
	ASAHI KASEI MEDICAL CO., LTD.
		
	By:	 	/s/ Yutaka Shibata
		 	Name: Yutaka Shibata
		 	Title: President

 [Signature Page to Subscription, Sale and Purchase Agreement] 

 Schedule 3.1 
 Subsidiaries 
  

			
	 Name
	  	Jurisdiction of
Incorporation
		
	 EIR Medical, Inc. (100% owned by NxStage Medical, Inc.)
	  	Massachusetts
		
	 NxStage Verwaltungs GmbH (100% owned by EIR Medical, Inc.)
	  	Germany
		
	 NxStage GmbH & Co. KG (100% of limited partnership interests owned by EIR Medical, Inc.; 100% of general partnership
interests owned by NxStage Verwaltungs GmbH)
	  	Germany
		
	 Medisystems Corporation (100% owned by NxStage Medical, Inc.)
	  	Washington
		
	 Medisystems Services Corporation (100% owned by NxStage Medical, Inc.)
	  	Nevada
		
	 Medimexico s. de R.L. de C.V. (100% owned by NxStage Medical, Inc.)
	  	Mexico
		
	 Medisystems Europe S.p.A (100% owned by NxStage Medical, Inc.)
	  	Italy
		
	 NxStage Medical UK Limited (100% owned by NxStage Medical Inc.)
	  	United Kingdom

 Schedule 3.11 
 Registration Rights 
 The Company has granted registration rights to DaVita Inc. pursuant
to the Registration Rights Agreement dated as of July 22, 2010, by and between the Company and DaVita Inc. 
 The Company has granted
registration rights to David S. Utterberg pursuant to the Investor Rights Agreement dated as of June 30, 1999, as amended on January 24, 2000, May 24, 2001, April 15, 2003, August 18,
2004, December 23, 2004 and July 8, 2005, by and among the Company and the Investors named therein.

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