UBS Global Life Sciences

Conference
September 22, 2009

| 2009 NxStage Medical Investor Presentation | Confidential

 Safe Harbor

This presentation contains certain “forward-looking” statements. These statements are based on the current estimates and
assumptions of the management of NxStage Medical, Inc. (or “NxStage” or “the Company”) as of the date of this presentation
and are naturally subject to uncertainty and changes in circumstances. Given these uncertainties, you should not place undue
reliance on these forward-looking statements. Actual results may vary materially from the expectations contained herein. When
used herein, the words “may”, “will”, “should”, “could”, “would”, “plan”, “anticipate”, “believe”, “estimate”, “intend”, “project”,
“potential” and “expect” and similar expressions are intended to identify such forward-looking statements. Such forward-looking
statements are subject to risks, uncertainties, assumptions and other factors that may cause the actual results of NxStage to be
materially different from those reflected in such forward-looking statements. Important factors that could cause actual results to
differ materially from those indicated by such forward-looking statements include, among others, those set forth under the
headings “Cautionary Note Regarding Forward-Looking Statements”, “Risk Factors” and “Management’s Discussion and
Analysis of Financial Condition and Results of Operations” in our Quarterly Report on Form 10Q for the quarter ended June 30,
2009. Except to the extent required by applicable securities laws, NxStage is not under any obligation to (and expressly
disclaims any such obligation to) update its forward-looking statements, whether as a result of new information, future events, or
otherwise. All statements contained in this presentation are made only as of the date of this presentation.

The Company discloses certain non-GAAP financial measures to supplement the Company's consolidated financial statements
presented on a GAAP basis. These non-GAAP measures are not in accordance with, or an alternative for, generally accepted
accounting principles in the United States and may be different from similar non-GAAP financial measures used by other
companies. The non-GAAP financial measures disclosed by the Company are not meant to be considered superior to, or a
substitute for, results of operations prepared in accordance with GAAP. Management uses Adjusted EBITDA (EBITDA adjusted
for stock based-compensation, deferred revenue recognized, and other non-recurring expenses) , and Adjusted Income to
understand operational cash usage. The Company believes this and other non-GAAP financial measures provide useful and
supplementary information allowing investors greater transparency to this measure used by management. These non-GAAP
financial measures are meant to supplement, and to be viewed in conjunction with, GAAP financial measures. A reconciliation to
the most comparable GAAP financial measure s can be found within the Company’s second quarter financial press release dated
August 5, 2009 at www.nxstage.com/ir.cfm.

2 | 2009 NxStage Medical Investor Presentation | Confidential

 FOUNDER, PRESIDENT AND CEO

JEFFREY BURBANK

| 2009 NxStage Medical Investor Presentation | Confidential

 About NxStage

• Leading provider of innovative

solutions for renal care within
Home, Critical Care and In-Center
Markets.
• Founded in 1998.
• IPO in 2005.
• NASDAQ: NXTM

• Headquarters in Lawrence, MA,

USA.
• Design centers in Germany, Italy and
Mexico.
• Distribution partner in UK.
System One ®
• Annual revenue of $128.8M (2008).

4 | 2009 NxStage Medical Investor Presentation | Confidential

 Investment Highlights

• Established leader within estimated $1Billion home

hemodialysis market.
• Transformational technology delivers enhanced quality of
life, clinical and economic benefits.
• Continued growth and leverage supported by strong,
existing infrastructure in critical care and in-center markets.
• Solid business fundamentals and improving financials.
• Early stages of international expansion.
• Strong and experienced management team.

5 | 2009 NxStage Medical Investor Presentation | Confidential

 $1.6B US Market Opportunity*:
Pioneering the Home Hemodialysis Market
US ESRD Market:1
 350,000 Patients with
$100M ESRD
 3-5% CAGR
 85% Medicare/Medicaid-
$1Billion 15% Private Pay
$500M
(Represents
10-15% of Prevalence of ESRD
ESRD Patients by Treatment
0.7%
Population) Modality1
7%
Center HD

PD

92% NxStage HHD

Home In-Center Critical Care
1
*NXTM’s estimate of potential U.S. product market size for each of the three markets. USRDS Annual Data Report 2008 (citing 2006 data,
excluding transplants.)

6 | 2009 NxStage Medical Investor Presentation | Confidential

Rethinking the Dialysis Paradigm

Daily Home Hemodialysis with the NxStage

System One™

Technical Therapeutic Clinical Economic

Innovation Flexibility Benefits Benefits

7 | 2009 NxStage Medical Investor Presentation | Confidential

Leveraging Technical Innovation For Patient Freedom

PrismaFlex

In the Home

2008K@HOME
Hemodialysis System

System One™ PureFlow™ SL

Aksys PHD

…or on the Road

System

Allient® Sorbent
Hemodialysis
System

Technical Therapeutic Clinical Economic

Economic
System One™ Innovation Flexibility Benefits Benefits
Benefits
8 | 2009 NxStage Medical Investor Presentation | Confidential
 Enabling Therapeutic Flexibility

Home
• Nocturnal*
Home
In-Center
every other • Nocturnal*
• 3x a week day Daily

Home Home Normal

• Every • Short Kidney
other Daily
day
Function

*There are currently no systems specifically indicated for nocturnal

hemodialysis. NxStage is currently undergoing an FDA IDE Clinical Trial for this
specific indication. Slide is intended to show therapeutic flexibility and does not
present any claims pertaining to any therapy’s ability to achieve normal kidney Technical Therapeutic Clinical Economic
function. Innovation Flexibility Benefits Benefits
9 | 2009 NxStage Medical Investor Presentation | Confidential
 Achieving Superior Clinical Outcomes
NxStage daily home hemodialysis (HHD) achieves
greater than 50% reduction in mortality.1
Overall USRDS

Peritoneal Dialysis (PD)

>50%
NxStage Daily HHD Reduction

0 5 10 15 20 25
Death Per 100 Patient Years
Source: NxStage analysis (1/2006 through 10/2007); PD literature (Guo, Mujais KI 2003 and 2006); 2007 USRDS Annual Report.
*Calculated NxStage age and gender adjusted SMR is approximately 50%, based on analysis of over 2,000 NxStage patients across more than
330 centers.
Technical Therapeutic Clinical Economic
Innovation Flexibility Benefits Benefits
10 | 2009 NxStage Medical Investor Presentation | Confidential
 Fewer Complications

The health benefits of more frequent hemodialysis have been

reported to be significant for a number of complications:

Clinical
Benefits

Source: Analysis of 94 original published articles published since 1996. Technical Therapeutic Clinical Economic
See “Benefits of Daily Dialysis” booklet (NxStage, 2005) Innovation Flexibility Benefits Benefits
11 | 2009 NxStage Medical Investor Presentation | Confidential
 Reducing the Cost of Care:
Decreasing Drug Utilization:
Patients who switched to daily HHD had a nearly 50% reduction
in the number of blood pressure medications prescribed.1

Economic
Benefits
Number of Prescribed % of Patients Prescribed No
Anti-Hypertensive Meds Per Anti-Hypertensive Medications1
Patient1 50%
1.7 1.4 p< 0.0001 45% p< 0.002
1.8
47%
1.6 40%
1.4 1.3 1.3 35%
39%
1.2 30%
1.0 1.3
1.0 25%
0.8 20%
21%
0.6 15%
0.4 10%
0.2 5%
0.0 0%
Baseline Month-4 Month-12 Baseline Month-4 Month-12

1 Jaber BL, et al. Daily hemodialysis (DHD) reduces the need

for anti-hypertensive medications. Abstract presentation at the Technical Therapeutic Clinical Economic
American Society of Nephrology 2009 Annual Congress. Innovation Flexibility Benefits Benefits
12 | 2009 NxStage Medical Investor Presentation | Confidential
©NxStage Medical Inc. 2009
 Improving Quality of Life:
NxStage FREEDOM Study Data

30% reduction in 6 to 17%

DEPRESSIVE improvement in
SYMPTOMS1 health-related
QUALITY OF LIFE
measures1

35% reduction in typical

weekly total dialysis care More than 85%
time commitment,** resulting reduction
in regaining roughly a waking in post-treatment
day per week, or 52 days per RECOVERY TIME1
year, of QUALITY TIME2
Source: 1 Finkelstein F, et al. Daily hemodialysis improves depressive symptoms at 12
months of follow-up: Interim results from the FREEDOM study. Hemodialysis
International. 2009: 13:1: 111. Presented as an abstract at the 2009 Annual
Conference on Dialysis.. 3 The FREEDOM Study: Important outcomes data for your
Technical Therapeutic Clinical Economic
dialysis patients. Comparative treatment times. APM325, Rev B. p3. Innovation Flexibility Benefits Benefits
13 | 2009 NxStage Medical Investor Presentation | Confidential
Building Momentum…

With Thousands of Patients… And Through Millions of Treatments.

 Over 85% of NxStage patients  A recent survey showed that 92%

surveyed report that they chose of NxStage prescribing physicians
HHD for the health, freedom and and 86% of non-NxStage
control benefits it offers.1 prescribers would choose home
dialysis for themselves.2
 89% of NxStage patients surveyed
are “Highly Likely” to recommend
 In a nephrologist and nurse survey,
HHD to a patient who is considering
77% of respondents chose
it.1
home/more frequent dialysis as the
best long-term therapy for the
majority of patients.3

1Chadwick Martin Bailey. NxStage Home Hemodialysis Patient Research. October, 2008. Pg. 1-44.
2Healthcare Research Consulting Group. NxStage Report. July 28, 2009. p. 1-64.
3Ledebo I and Ronco C. The best dialysis therapy? Results from an international survey among nephrology professionals. Nephrol Dial Transplant Plus. 2008; 6:403-

408.

14 | 2009 NxStage Medical Investor Presentation | Confidential

 Driving Adoption Growth

Drivers for Adoption

 Reimbursement
 Clinical Support
 “Going Deep”
 Product

15 | 2009 NxStage Medical Investor Presentation | Confidential

Home Market Highlights

 CMS’s Proposed “Bundled” Payment.

− NxStage will be focused on improving In Millions
training reimbursement. $16
$14
 Home revenue increased 28% in $12
Q209 vs. Q208. $10
$8
 Increased centers >10 patients to 99
$6
in Q209.
$4
 Increased markets with > 5% $2
penetration by 79% in Q209 vs. $0
Q208. Q107 Q207 Q307 Q407 Q108 Q208 Q308 Q408 Q109 Q209

 Increased # of prescribing doctors by Home Revenue

24% in Q109 vs. Q208.

16 | 2009 NxStage
Source: Medical
NxStage InvestorSecond
Medical Presentation | Confidential
Quarter 2009 Financial Results Conference Call on August 5, 2009.
Critical Care Highlights

• Respected leader in CRRT since 2003.

– Represent an estimated 25% of installed Market Opportunity*
critical care dialysis machines in US.
– Customers include 7 of top 10 leading renal
care hospitals in US (US News & World $100M
Report 2008).
• Strong, differentiated value proposition.
• Continue to expand market presence. $500M
$1B
– Increased revenues 20% in Q209 vs. Q208.
• Strategic to overall growth and
profitability.
– Predictable, recurring revenue stream.
• Approx. 80% of revenue is disposables
based. Home In-Center Critical Care
– Machine sales contribute to cash flow.
*NXTM’s estimate of potential U.S. product market size for
each of the three markets.

17 | 2009 NxStage Medical Investor Presentation | Confidential

 In-Center Highlights

• Established leader since 1993. (Acquired

in 2007.)
– #1 Market Share Leader in US AVF Needle
Market Opportunity*
Market.1
– #2 Market Share Leader in US Bloodline $100M
Market.1
• Innovative, value- added products.
$500M
• Manufacturing scale. $1B
– Leverage to further reduce COGS, increase
capacity and improve efficiency.
• Strategic channel opportunities.
– Expand market reach across all three
markets.
Home In-Center Critical Care

1Manufacturers’ public disclosures, NXTM actual results & competitive estimates for *NXTM’s estimate of potential U.S. product market
2008. size for each of the three markets.
18 | 2009 NxStage Medical Investor Presentation | Confidential
 New Strategic Business Agreements

19 | 2009 NxStage Medical Investor Presentation | Confidential

 Financial Highlights: Rapid Revenue Growth

$140 $128.8
$120
$100
Millions

$80 $60.0
$60
$40 $20.8
$20 $6.0
$0
2005 2006 2007 * 2008
System One In-Center

*Reflects the impact of the Company’s acquisition of Medisystems, the Company’s in-center business, in October, 2007.

| 2009 NxStage Medical Investor Presentation | Confidential

 Improving Gross Margins and Adjusted EBITDA

Gross Margin Adjusted EBITDA (Loss)*

($M)
30%
$0
25%
24%
20% 21%
20% ($5) -3.4
16%
15% 13% 14% -6.0 -5.7
($10) -8.3 -7.7 -7.3
10%
-11.7
5% 2% ($15)
0% Q4FY07 Q1FY08 Q2FY08 Q3FY08 Q4FY08 Q1FY09 Q2FY09
Q4FY07 Q1FY08 Q2FY08 Q3FY08 Q4FY08 Q1FY09 Q2FY09
*Non-GAAP Measure: Excludes depreciation and amortization, stock-based
compensation, deferred revenue recognized and other non-recurring
expenses. A reconciliation to the most comparable GAAP financial measure
can be found within the Company’s second quarter financial press release
dated August 5, 2009 at nxstage.com/ir.cfm.

21 | 2009 NxStage Medical Investor Presentation | Confidential

Key Financial Matrix
In Millions
Q2FY08 Q1FY09 Q2FY09 Q3FY09
Guidance*
Revenue $31.6 $33.7 $36.4 $32.5-$34.51

Gross Margin 14% 21% 24%

Net Income $(12.5) $(12.2) $(12.5) $(10.0)-

(Loss) Adj. $(14.6)2 Adj. $(10.5)3 $(11.0)

Adj. EBITDA $(7.7) $(5.7) $(3.4) $(3.0)-$(4.0)

(Loss)4

* Q3FY09 Guidance provided on August 5, 2009 within Company’s second quarter financial press release at nxstage.com/ir.cfm.
1 Estimate includes the impact of $2.0mm in In-Center shipments being pushed from Q3 to Q4FY09.
2 Non-GAAP Measure: Excludes a $2.1mm benefit related to a change in fair value of financial instruments.
3 Non- GAAP Measure: Excludes the impact of $2.0mm in charges related to terminating the Company’s GE Credit facility.
4 Non-GAAP Measure: Excludes depreciation and amortization, stock-based compensation, deferred revenue recognized and other non-recurring

expenses.

22 | 2009 NxStage Medical Investor Presentation | Confidential

 Thank you!

Questions?

| 2009 NxStage Medical Investor Presentation | Confidential