Fresenius Medical Care AG & Co. KGaA (NYSE:FMS) reported a sharp improvement in profitability in its 2025 financial year and laid out a 2026 outlook that management described as a deliberate “transition year,” reflecting both investment needs and the phaseout of certain temporary benefits.
Speaking at the company’s annual press conference, Chief Executive Officer Helen Giza said 2025 marked the culmination of the company’s “FME25” turnaround and transformation, and highlighted the launch of a new long-term strategy, “FME Reignite,” introduced in June with a 2030 horizon. CFO Martin Fischer joined Giza for Q&A and provided more detailed figures on expected 2026 headwinds and investments.
2025 results: higher margins, stronger earnings, and savings progress
Giza also said earnings per share increased 44%, attributing the rise to earnings strength and the impact of an accelerated share buyback program. Net leverage improved to 2.5x, which she described as the bottom end of the company’s lowered target corridor, down from 3.4x at the end of 2022.
On cost actions, management said the FME25 program exceeded its original targets. Against an initial target of EUR 500 million in sustainable savings, the company achieved EUR 804 million by year-end 2025, and is “on track” to deliver EUR 1.2 billion in sustainable savings by 2027. Giza said the expanded initiative, FME25+, is also “exceeding expectations.”
Segment commentary and operational themes
Management said all three operating segments contributed to 2025 performance:
- Care Delivery: Giza cited savings from FME25+ and “positive rate and payer mix effects.” She also pointed to a tailwind from TDAPA, a temporary U.S. Medicare add-on payment for innovative dialysis drugs. She said U.S. same-market treatment growth was flat in 2025, but management continues to see a midterm recovery to 2%+ tied to quality initiatives and the impact of the 5008X platform.
- Value-Based Care: Giza said the segment delivered positive operating income for the full year. The company reported 34% revenue growth driven by contract expansion and member-month growth. Management said performance was helped by a favorable savings rate, partly offset by an unfavorable effect from CMS’ CKCC program.
- Care Enablement: Management cited higher volumes and positive pricing, though noted negative impacts from volume-based procurement and other regulatory policies in China. Giza said footprint optimization across manufacturing and supply chain continued as part of FME25+.
Giza added that Fresenius Medical Care generated EUR 2.7 billion in operating cash flow in 2025. The company repurchased EUR 586 million of shares in 2025, completing the first tranche of an initial EUR 1 billion buyback program over two years; in January 2026, the company initiated the next tranche of around EUR 414 million, expected to conclude by May 2026.
For the 2025 financial year, management said it plans to propose a dividend of EUR 1.49, representing a 3% increase from 2024 and corresponding to a payout of 33% of adjusted net income, aligned with its target payout ratio of 30% to 40%.
5008X and HDF rollout: “largest product launch” in company history
A central theme of the call was Fresenius Medical Care’s rollout of hemodiafiltration (HDF) therapy in the United States using its 5008X machine. Giza called it “the largest product launch in our company’s history” and said HDF has been the standard of care in Europe, Latin America, and Asia Pacific for more than a decade.
Giza cited results from the CONVINCE study, describing it as an international randomized trial comparing HDF with standard high-flux hemodialysis. She said the study reaffirmed outcomes including a 23% lower risk of mortality for patients treated with high-volume HDF compared with standard hemodialysis, along with improvements in patient well-being and recovery and reduced mistreatments.
In 2025, the company introduced the 5008X in select U.S. clinics. Giza said feedback was “overwhelmingly positive,” citing patient reports of increased energy and shorter recovery times and staff feedback around more automated workflows.
For 2026, Fresenius Medical Care plans to begin replacing approximately 20% of devices in its U.S. clinics across 28 states, transitioning about 36,000 patients to HDF and training more than 7,200 staff in a single year. Giza said the effort is expected to support improved outcomes and differentiation and may help drive admissions and consumables growth.
2026 outlook: flat revenue, steady operating income, and quantified headwinds
Despite the 2025 step-up, management’s 2026 outlook was cautious. Giza said the company is comparing against a “very high base” and that TDAPA-related benefits begin to phase out during 2026. She said the goal is to maintain the enhanced profitability level while investing for future value creation and navigating regulatory headwinds.
Fischer provided a framework for 2026 assumptions, saying the company expects:
- EUR 250 million to EUR 350 million contribution from business growth
- About EUR 250 million in savings from the transformation program
- EUR 200 million to EUR 300 million in inflationary impacts (including typical 3% labor inflation net of efficiencies)
- EUR 150 million to EUR 200 million in regulatory headwinds
- EUR 100 million to EUR 150 million of investments tied to the HDF rollout and IT platform harmonization (including SAP S/4HANA)
Giza said the 2026 strategic investments range includes the 5008X rollout costs, and later clarified that roughly half of the EUR 100 million to EUR 150 million investment envelope is related to HDF, with upfront training costs expected to be offset as benefits emerge, particularly in the second half of the year.
At group level, management’s outlook implies a 10.5% to 12% operating income margin range for 2026. While the company expects care delivery and care enablement to grow, it is assuming broadly flat revenue growth overall, which management attributed largely to changes in value-based care risk contracting and related revenue reductions. For earnings, the company expects operating income to remain at a consistent level, with an upside/downside range described as a mid-single-digit percentage change.
Other topics: U.S. volumes, tariffs, and German manufacturing sites
On U.S. same-market treatment volumes, Giza said the company saw flat growth through 2025 and is projecting a similar level in 2026. She pointed to a higher level of mortality and mistreatments, compounded by flu season and severe weather, and reiterated confidence in returning to 2%+ growth once mortality normalizes. However, she did not provide a specific quarter or half-year for when normalization would occur, saying improvements should be gradual.
Asked about U.S. tariff changes, Giza said tariffs were “very immaterial” to the company in 2025 due in part to product classifications and a large U.S. footprint with local production. She said tariffs could affect purchased goods sourced from overseas and that the 2026 outlook reflects tariffs in place as of the prior Friday, while calling the situation fluid. She added the company would pursue refunds if an opportunity emerges.
On investment locations in Germany, Giza highlighted two major manufacturing plants in Schweinfurt and Sindelfingen, describing them as high-volume producers for dialyzers and the new machine. Fischer added that the company has made acquisitions of those manufacturing plants and is investing in them alongside the product rollout, while emphasizing Fresenius Medical Care’s broader “local for local” global manufacturing network.
About Fresenius Medical Care AG & Co. KGaA (NYSE:FMS)
Fresenius Medical Care AG & Co KGaA is the world’s largest integrated provider of products and services for individuals with renal diseases. The company’s primary business activities encompass the operation of dialysis clinics and the manufacture and distribution of dialysis equipment, dialysis machines, dialyzers, consumables and related therapies. Through its global network of clinics, Fresenius Medical Care delivers comprehensive kidney care, including hemodialysis and peritoneal dialysis treatments, patient education and support services.
In its products segment, the company designs and produces dialysis machines, water treatment systems and disposables such as high‐flux dialyzers and bloodlines.
