Financial Trends -- 5/10
A turnaround/transition story: reported growth is messy and decelerating (deliberate clinic exits,
divestitures, FX, and a VBC accounting reset), while the underlying margin and cash-deleveraging
trajectory is steadily improving under the FME25/FME25+ cost program. The most important growth proof
point — U.S. treatment volume — has NOT turned. Free cash flow is positive but volatile and below its
2023 peak. A balanced 5/10: margin/cash recovery offsets top-line deceleration. No penalty modifiers.
Weight: 25%
OI ex-SI Margin
Expanding
10.1% Q1'26 vs 9.4% Q1'25 | +70 bps YoY
Net Leverage
2.5x
From 3.4x | De-levering
Share Count
Declining
293.4M → 275.2M | Buyback-driven
Quarterly metrics (EUR, last 9 quarters)
| Metric | Q1'24 | Q2'24 | Q3'24 | Q4'24 | Q1'25 | Q2'25 | Q3'25 | Q4'25 | Q1'26 |
|---|---|---|---|---|---|---|---|---|---|
| Revenue (€M) | 4,724.5 | 4,766.4 | 4,760.2 | 5,085.0 | 4,881.5 | 4,791.7 | 4,885.0 | 5,070.0 | 4,612.0 |
| Revenue YoY | — | — | — | — | +3.3% | +0.5% | +2.6% | -0.3% | -6.0% |
| Gross profit (€M) | 1,173.7 | 1,166.5 | 1,146.1 | 1,271.0 | 1,184.0 | 1,214.4 | 1,242.0 | 1,389.0 | 1,179.0 |
| Gross margin | 24.8% | 24.5% | 24.1% | 25.0% | 24.3% | 25.3% | 25.4% | 27.4% | 25.6% |
| OI GAAP (€M) | 246.0 | 424.8 | 462.7 | 259.0 | 331.4 | 425.3 | 477.0 | 594.0 | 286.0 |
| OI ex-SI margin | n/a | n/a | n/a | n/a | 9.4% | 9.9% | 11.8% | 13.9% | 10.1% |
| FCF (€M) | -2 | 289 | 815 | 599 | 21 | 628 | 550 | 583 | 40 |
| U.S. treatments (M) | 7.63 | 7.78 | 7.89 | 7.91 | 7.55 | 7.78 | 7.86 | 7.89 | 7.51 |
| Net leverage (x) | 3.2 | 3.1 | 2.8 | 2.9 | 2.8 | 2.7 | 2.6 | 2.5 | 2.6 |
Reported revenue is decelerating, turning negative in the last two prints
(-0.3% Q4'25, -6.0% Q1'26). The deceleration is largely self-inflicted/optical — deliberate
U.S. clinic closures, divestitures, FX, and a VBC revenue-recognition reset — even as management reports
organic revenue +4%. Margins, by contrast, are genuinely expanding: OI ex-SI margin
10.1% in Q1'26 vs 9.4% Q1'25 (+70 bps YoY), gross margin +~100 bps off the 2024Q3 trough (24.1%).
Same-market treatment growth (the management KPI) was -37 bps in Q1'26.
Acceleration / deceleration (sequential YoY on revenue)
| YoY pair | Rate | Direction |
|---|---|---|
| Q1'24 → Q1'25 | +3.3% | base |
| Q2'24 → Q2'25 | +0.5% | decel |
| Q3'24 → Q3'25 | +2.6% | re-accel |
| Q4'24 → Q4'25 | -0.3% | decel |
| Q1'25 → Q1'26 | -6.0% | sharp decel |
Annual financial summary (5-year, EUR; FY ends December)
| Metric | FY2021 | FY2022 | FY2023 | FY2024 | FY2025 |
|---|---|---|---|---|---|
| Revenue (€M) | 17,618.7 | 19,398.0 | 19,453.6 | 19,335.9 | 19,627.6 |
| Revenue YoY | — | +10.1% | +0.3% | -0.6% | +1.5% |
| Gross profit (€M) | 5,077.0 | 5,310.3 | 4,925.0 | 4,756.7 | 5,028.9 |
| Gross margin | 28.8% | 27.4% | 25.3% | 24.6% | 25.6% |
| OI GAAP (€M) | 1,852.3 | 1,511.8 | 1,369.4 | 1,392.4 | 1,827.0 |
| EPS ex-SI (€) | n/a | 2.48 | 2.57 | 3.08 | 4.28 |
| EPS ex-SI YoY | — | — | +3.6% | +19.8% | +39.0% |
| FCF (€M) | 1,660 | 1,480 | 1,960 | 1,701 | 1,782 |
| Net debt (€M) | 11,838 | 11,939 | 10,760 | 9,803 | 9,196 |
| Dialysis clinics | 4,171 | 4,116 | 3,925 | 3,675 | 3,601 |
Key trends
- Revenue essentially flat: €17.6B (2021) to €19.6B (2025), ~+1.5% five-year CAGR — a margin/cost-out story, not a growth-leader story
- Margins troughed and recovering: gross margin bottomed at 24.6% (2024) and recovered to 25.6% (2025); GAAP OI rebounded to €1,827M (2025), the highest in the window
- EPS ex-SI rising sharply: €2.48 (2022) to €4.28 (2025) on cost-out and deleveraging, not volume
- Steady deleveraging: net debt €11.8B (2021) to €9.2B (2025); net leverage 3.4x → 2.5x
- Clinic footprint pruned: 4,171 (2021) to 3,601 (2025) as the company exits sub-scale/non-core markets
Segment revenue (EUR M, latest quarter Q1'26)
Care Delivery's decline is a VBC reclass, not lost patients.
Care Delivery fell 3,945 → 3,097 €M Q4 YoY as Value-Based Care was carved out into its own reported
segment. The FY2025 roll-up (Care Delivery €13,736.3m, Care Enablement
€5,476.2m) consolidates VBC into Care Delivery, which is why the
annual mix shows Care Delivery higher (~70%) than the quarterly view (~64%).
Scoring logic
Base score: 5/10 — a mixed/neutral profile against the rubric.
- Revenue YoY: decelerating (rubric pushes toward 1). Reported revenue turned negative (-6% in Q1'26), though this is largely portfolio pruning / FX / accounting rather than demand loss (organic +4%).
- Margins: expanding (rubric pushes toward 10) — the strongest positive. OI ex-SI margin +70 bps YoY (10.1% Q1'26 vs 9.4% Q1'25); gross margin +~100 bps off the 2024Q3 trough. Clearly expanding.
- Share count: declining (positive). Weighted-avg shares fell from ~293.4M (2024Q4) to ~275.2M (2026Q1) — buyback/cancellation, not dilution.
- FCF: positive but not accelerating. Annual FCF (€1,960M → €1,701M → €1,782M) sits below the 2023 peak; Q1'26 FCF (€40M) is up vs Q1'25 (€21M) but both are near-zero seasonal troughs. Positive and broadly stable, not clearly growing — neutral.
The expanding margins, declining share count, and steady deleveraging (3.4x → 2.5x) are genuine strengths that argue above a 5. But decelerating/negative reported revenue, the still-unturned core U.S. volume KPI, and FCF that has not exceeded its 2023 level cap the improvement. Net: a balanced 5/10 — flat-to-improving fundamentals where margin/cash recovery offsets top-line deceleration.
Penalty modifiers (applied after base): Negative FCF: NO. Share dilution >10%: NO (declining). Revenue up but OI down: N/A (revenue declining, OI ex-SI rising). Debt growing faster than revenue 3+ qtrs: NO (debt shrinking). No penalties apply. Final score: 5/10.
Composite gate — positive/growing FCF: YES (positive every period, modestly growing YoY off the 2024 dip; caveat: below the 2023 peak).
Data sourced from Daloopa. Reports in EUR; fiscal year ends December 31. Latest reported quarter: 2026Q1.