Financial Trends -- 6/10
FMS is a genuine turnaround story with strong margin recovery under FME25+, but revenue growth
remains anemic on a reported basis (flat to low-single-digit). Operating income surged +31% YoY in
FY2025, driven by EUR 804M cumulative sustainable savings plus ~EUR 310M of temporary TDAPA
phosphate binder and catheter lock tailwinds that begin phasing out in 2026. Treatment volumes are
stagnant (U.S. SMTG ~0%) and patient count continues declining. Cash flow generation improved
materially; net leverage fell to 2.5x. Reports in EUR.
Weight: 25%
FY25 Revenue
€19.6B
+1.5% reported | +8% organic
FY25 Operating Income
€1,827M
+31.2% YoY | 9.3% margin
FY25 EBITDA excl. SI
€3,689M
18.8% margin | +150bps YoY
Net Leverage
2.5x
Down from 3.4x in FY22
Annual Financial Summary (EUR M, FY ends December)
| Metric | FY2021 | FY2022 | FY2023 | FY2024 | FY2025 |
|---|---|---|---|---|---|
| Total Revenue | €17,619M | €19,398M | €19,454M | €19,336M | €19,628M |
| Rev YoY (Reported) | — | +10.1% | +0.3% | -0.6% | +1.5% |
| Organic Growth | — | — | +4% | +4% | +8% |
| Operating Income | €1,852M | €1,512M | €1,369M | €1,392M | €1,827M |
| OI Margin | 10.5% | 7.8% | 7.0% | 7.2% | 9.3% |
| OI YoY | — | -18.4% | -9.4% | +1.7% | +31.2% |
| EBITDA excl. SI | — | €3,243M | €3,370M | €3,349M | €3,689M |
| EBITDA excl. SI Margin | — | 16.7% | 17.3% | 17.3% | 18.8% |
| Diluted EPS (EUR) | 3.31 | 2.30 | 1.70 | 1.83 | — |
| Operating Cash Flow | €2,489M | €2,167M | €2,629M | €2,386M | €2,681M |
| CapEx | (€854M) | (€724M) | (€685M) | (€699M) | (€915M) |
| Free Cash Flow | €1,660M | €1,480M | €1,960M | €1,701M | €1,782M |
| Net Debt | €11,838M | €11,939M | €10,760M | €9,803M | €9,196M |
| Net Leverage | 3.3x | 3.4x | 3.2x | 2.9x | 2.5x |
| Buybacks | — | — | — | — | (€585M) |
| Wtd Avg Shares (M) | 293M | 293M | 293M | 293M | 291M |
Note: FMS reports under IFRS in EUR. FY2025 Care Delivery revenue declined due to carve-out of
Value-Based Care as a separate segment (VBC generated >EUR 2B in FY2025). FY2025 EPS not yet
available in Daloopa; management reported ~EUR 4.5 adj. EPS and +68% EPS growth. FCF = company
definition (OCF less net CapEx). Organic growth from company transcripts.
Reported revenue is essentially flat over four years
(EUR 19.4B in FY2022 vs
EUR 19.6B in FY2025).
FX headwinds, portfolio divestitures, and flat treatment volumes mask the underlying organic
improvement. Organic growth accelerated to +8% in FY2025 (+400bps YoY), but was substantially
driven by VBC segment growth (+34% organic, largely revenue recognition) and TDAPA-related
pharma revenue. Core Care Delivery organic growth was ~5% (rate/mix, not volume).
Segment Breakdown (EUR M, Annual)
| Metric | FY2022 | FY2023 | FY2024 | FY2025 |
|---|---|---|---|---|
| Care Delivery Revenue | €15,593M | €15,578M | €15,275M | €13,736M |
| Care Enablement Revenue | €5,353M | €5,345M | €5,557M | €5,476M |
| Value-Based Care Revenue | — | — | — | €2,247M |
| CD Operating Income | €1,686M | €1,516M | €1,190M | €1,614M |
| CD OI Margin | 10.8% | 9.7% | 7.8% | 11.8% |
| CE Operating Income | (€30M) | (€67M) | €267M | €326M |
| CE OI Margin | -0.6% | -1.2% | 4.8% | 6.0% |
| VBC Operating Income | — | — | — | €1M |
| VBC OI Margin | — | — | — | 0.1% |
| Group OI Margin | 7.8% | 7.0% | 7.2% | 9.3% |
Margin recovery is the headline story. FME25+ turnaround
delivered EUR 804M cumulative sustainable savings. Care Delivery margin swung +400bps from trough
of 7.8% (FY2024) to
11.8% (FY2025). Care Enablement went
from -1.2% (FY2023) to
+6.0% (FY2025). VBC turned breakeven
for the first time (EUR 1M OI vs -EUR 28M prior year).
Q4 2025 CD margin of 17.0% was heavily boosted by ~EUR 70M of
catheter lock TDAPA + phosphate binders. The normalized CD margin is closer to 13-14%.
CE organic growth decelerated to +2% in FY2025, weighed down by China regulatory headwinds
(volume-based procurement, tender delays). 2026 outlook calls for ~EUR 300M VBC revenue decline
(risk contracting changes).
Quarterly Revenue and Profitability (Q1 2024 through Q4 2025)
| Metric | Q1 24 | Q2 24 | Q3 24 | Q4 24 | Q1 25 | Q2 25 | Q3 25 | Q4 25 |
|---|---|---|---|---|---|---|---|---|
| Revenue | €4,725M | €4,766M | €4,760M | €5,085M | €4,881M | €4,792M | €4,885M | €5,070M |
| Rev YoY (Reported) | — | — | — | — | +3.3% | +0.5% | +2.6% | -0.3% |
| Organic Growth | +5% | +2% | +2% | +1.9% | +5% | +7% | +10% | ~8% |
| Operating Income | €246M | €425M | €463M | €259M | €331M | €425M | €477M | €594M |
| OI Margin | 5.2% | 8.9% | 9.7% | 5.1% | 6.8% | 8.9% | 9.8% | 11.7% |
| OI YoY | — | — | — | — | +34.7% | +0.1% | +3.0% | +129.4% |
| EBITDA excl. SI | €797M | €825M | €843M | €884M | €845M | €840M | €931M | €1,074M |
Q4 2025 was exceptional: OI of
EUR 594M (+129% YoY) at 11.7% margin,
and EBITDA excl. SI of
EUR 1,074M (21.2% margin).
Organic growth accelerated from +2% in Q2-Q3 2024 to +10% in Q3 2025, though this was partly
driven by VBC revenue recognition and TDAPA pharma revenue. Reported revenue was roughly flat
to slightly negative in Q4 2025 (-0.3% YoY) due to FX headwinds and VBC comparables.
Quarterly Segment OI Margins
Care Delivery margin expanded YoY in every quarter of FY2025:
+340bps (Q1), +140bps (Q2), +120bps (Q3), +1070bps (Q4). The Q4 2025 CD margin of 17.0%
includes ~EUR 70M of temporary TDAPA catheter lock solutions and phosphate binder contributions.
CE margin expanded +150 to +190bps YoY in Q1-Q3 2025 before dipping -40bps YoY in Q4 2025,
reflecting China regulatory headwinds.
Free Cash Flow and Leverage (EUR M)
Cash Flow and Leverage (EUR M, Annual)
| Metric | FY2021 | FY2022 | FY2023 | FY2024 | FY2025 |
|---|---|---|---|---|---|
| Operating Cash Flow | €2,489M | €2,167M | €2,629M | €2,386M | €2,681M |
| CapEx | (€854M) | (€724M) | (€685M) | (€699M) | (€915M) |
| Free Cash Flow | €1,660M | €1,480M | €1,960M | €1,701M | €1,782M |
| Net Debt | €11,838M | €11,939M | €10,760M | €9,803M | €9,196M |
| Adj EBITDA TTM | €3,563M | €3,550M | €3,391M | €3,378M | €3,737M |
| Net Leverage | 3.3x | 3.4x | 3.2x | 2.9x | 2.5x |
| Buybacks | — | — | — | — | (€585M) |
Cash generation improved materially. OCF reached
EUR 2,681M (13.7% of revenue, +140bps
YoY). Net leverage improved to
2.5x (down from 3.4x in FY2022).
Capital allocation turned shareholder-friendly: EUR 585M in buybacks in FY2025 (4.8% of share
capital, EUR 1B program announced). Dividend of EUR 1.49 per share (33% payout). CapEx increased
to EUR 915M in FY2025 reflecting 5008X/HDF rollout investments.
Volume and Operational KPIs
Volume is the Achilles heel. Patient count has declined
~16% since FY2021 (345K to 290K), reflecting portfolio divestitures and elevated mortality.
Clinic count down ~14% (4,171 to 3,600). U.S. same-market treatment growth: flat/slightly
positive through 2025 (+0.1% in Q3 2025). International SMTG: +1.2% to +1.7%. The company
is guiding flat SMTG for 2026 and plans to close ~100 more clinics. The long-term 2%+ SMTG
target remains aspirational until mortality normalizes.
Acceleration / Deceleration Analysis
| Metric | FY23 vs FY22 | FY24 vs FY23 | FY25 vs FY24 | Direction |
|---|---|---|---|---|
| Revenue Growth (Reported) | -980bps | -90bps | +210bps | Accelerating |
| Organic Growth | flat | flat | +400bps | Accelerating |
| OI Growth | +900bps | +1,110bps | +2,950bps | Accelerating |
| OI Margin | -80bps | +20bps | +210bps | Accelerating |
| EBITDA Margin (excl. SI) | +60bps | flat | +150bps | Accelerating |
Clear inflection across all profitability metrics.
OI growth trajectory: -18.4% to -9.4% to +1.7% to +31.2% -- textbook turnaround acceleration.
OI margin expanded +210bps FY (7.2% to 9.3%). EBITDA margin +150bps (17.3% to 18.8%).
However, the acceleration is front-loaded by temporary TDAPA items (~EUR 310M in FY2025) and
2026 guidance calls for flat OI (mid-single-digit +/- range).
2026 Guidance and Outlook
| Metric | FY2025 Actual | 2026 Outlook | Key Driver |
|---|---|---|---|
| Revenue | €19.6B | Broadly flat | VBC -~€300M offset by CD/CE growth |
| Operating Income | €1,827M | Mid-single-digit +/- range | TDAPA phase-out offset by FME25+ savings |
| TDAPA Headwind | €310M tailwind | €150-200M headwind | Phosphate binders + catheter locks phase out H2 26 |
| FME25+ Savings | €804M cumulative | €1.2B by end-2027 | €400M more in 2026-27 |
| 5008X/HDF Rollout | — | ~20% installed base | OpEx headwinds year 1; benefits from 2027+ |
| SMTG | ~0% | Flat | Mortality still elevated; ~100 more clinic closures |
| 2028 CAGR Target | — | 3-7% OI growth | Low teens excluding TDAPA noise |
2026 is a transition year. Large-scale 5008X/HDF rollout targeting ~20% of
installed base creates significant year-1 OpEx (training 7,200+ nurses, converting 36,000
patients). TDAPA phosphate binders (EUR 220M in 2025) and catheter locks (EUR 90M in 2025)
begin phasing out in H2 2026, creating EUR 150-200M headwind. FME25+ savings (EUR 400M more
targeted for 2026-27) are expected to offset. Benefits from HDF expected from 2027 onward.
Penalty / Modifier Assessment
| Factor | Impact | Detail |
|---|---|---|
| TDAPA windfall dependency | -1.00 | EUR 220M phosphate binders + EUR 90M catheter locks in 2025 are temporary; EUR 150-200M headwind in 2026 |
| Flat treatment volume | -0.50 | U.S. SMTG ~0% for 3+ years; patient count declining; 2%+ target aspirational |
| 2026 guidance: flat OI | -0.50 | Mid-single-digit +/- range; transition year with rollout costs and TDAPA phase-out |
| China headwinds in CE | -0.25 | Regulatory/tender delays reducing CE growth; EUR 50M EBIT impact in 2025 |
| Strong FME25+ execution | +0.50 | EUR 804M cumulative savings; EUR 400M more targeted for 2026-27 |
| Cash flow improvement / deleveraging | +0.25 | OCF up to 13.7% of revenue; net leverage to 2.5x; buyback program |
| Share buyback accretion | +0.25 | 4.8% of shares repurchased in 2025; EUR 1B program accelerated |
Net modifier impact: -1.25 pts (-2.25 penalties offset by
+1.00 positives). Base score of 5 adjusted to 6.0 after +1.5 for strong margin
acceleration, +0.5 for FME25+ execution and cash flow, -0.5 for TDAPA dependency, and -0.5
for flat volume/patient decline. A turnaround that has delivered on cost/margin improvement
but has not yet demonstrated sustainable top-line growth.
Transcript Context (Q3 2025 and Q4 2025)
FME25+ over-delivered: EUR 804M cumulative sustainable savings vs original
targets. Upgraded to EUR 1.2B by end of 2027. The cost transformation is the most credible
part of the thesis -- management has consistently beaten its own targets.
TDAPA tailwinds are temporary: Phosphate binders contributed EUR 220M in 2025
(originally guided EUR 100M). Catheter lock solutions added EUR 90M. Both begin phasing out
in H2 2026. This is the single largest risk to the FY2026 earnings bridge.
5008X/HDF rollout is the key catalyst: Large-scale 2026 rollout targeting ~20%
of installed base. Significant OpEx headwinds in year 1 (training 7,200+ nurses, converting
36,000 patients). Benefits expected from 2027+. This is the bridge from turnaround to
sustainable growth.
Volume remains the Achilles heel: U.S. SMTG flat. Mortality still elevated.
Missed treatments elevated. Management continues to target 2%+ once mortality normalizes but
has been saying this for 2+ years. The next 12-18 months are a critical test: can HDF rollout,
mortality normalization, and continued FME25+ savings offset the TDAPA phase-out?
Daloopa (company_id: 151435) and FMS earnings call transcripts (Q2-Q4 2025)