Fresenius Medical Care delivers strong operating income growth in Q1 2026 while advancing the U.S. rollout of 5008X CAREsystems at speed

Fresenius Medical Care (NYSE:FMS) reported Q1 2026 results with organic revenue growth of 4% and operating income excl. special items up 2% to €467m (margin 10.1%).

Rhea-AI Summary

Fresenius Medical Care (NYSE:FMS) reported Q1 2026 results with organic revenue growth of 4% and operating income excl. special items up 2% to €467m (margin 10.1%). Reported operating income fell 14% to €286m and net income declined 22% to €118m, driven by FME25+ one-time costs of €166m. The company confirmed its 2026 outlook and highlighted the rapid U.S. rollout of the 5008X CAREsystem (~100 clinics, >100,000 treatments). Share buybacks of €941m repurchased 23.3m shares by March 31, 2026.

Positive

• Operating income excl. special items +2% to €467m
• Operating margin excl. special items 10.1%
• Basic EPS excl. special items +8% to €0.91
• FME25+ delivered €50m sustainable savings in Q1
• Share buyback €941m repurchased 23.3m shares
• 5008X rollout ~100 clinics, >100,000 treatments performed

Negative

• Reported operating income -14% to €286m
• Reported net income -22% to €118m
• FME25+ one-time costs €166m in Q1 (€350m expected in 2026)
• Group revenue -6% to €4,612m (currency headwinds)
• U.S. same-market treatment growth -0.4%

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On May 5, the day this news came out, FMS closed 10.86% below the previous close.

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Key Figures

Q1 2026 revenue: €4,612m Op. income excl. special: €467m EPS excl. special: €0.91 +5 more

Q1 2026 revenue

€4,612m

Group revenue Q1 2026 vs €4,881m in Q1 2025

Op. income excl. special

€467m

Q1 2026 operating income excl. special items; 10.1% margin

EPS excl. special

€0.91

Basic EPS excl. special items in Q1 2026; up 8.5% yoy

Operating cash flow

€227m

Q1 2026 operating cash flow; up 39% yoy, 4.9% margin

Free cash flow

€40m

Q1 2026 free cash flow; up 94% yoy, 0.9% margin

FME25+ Q1 savings

€50m

Additional sustainable savings from FME25+ in Q1 2026

FME25+ target savings

€1.2bn

Cumulative FME25+ savings expected by end of 2027

Share buyback program

€1.0bn / 24.8m shares

Initial buyback; 8.5% of share capital repurchased

Historical Context

4 past events · Latest: Feb 24

4 events

1. Feb 24

   Full-year earnings

   24h Move

   -7.8%

   Strong 2025 earnings growth and margins reaching mid-term target band.

2. Jan 15

   Product rollout

   24h Move

   +1.1%

   Growth in U.S. home hemodialysis and launch of VersiHD with GuideMe.

3. Jan 09

   Share buyback

   24h Move

   +1.4%

   Acceleration of second tranche of €1.0bn share buyback program.

4. Dec 10

   Management change

   24h Move

   +3.0%

   Appointment of new Global Chief Medical Officer and board member.

24h Move is the share-price change in the day after each event; other market factors may also have contributed.

Key Terms

tdapa, value-based care, ebitda, net leverage ratio, +4 more

8 terms

tdapa regulatory

"Care Delivery posted strong operating income growth supported by positive TDAPA effects."

A transitional drug add-on payment adjustment (TDAPA) is a temporary Medicare payment rule that gives hospitals higher reimbursement for newly available drugs or biologic treatments that are not yet reflected in standard outpatient payment rates. Think of it as a short-term price support that helps hospitals afford and use a new therapy while payers gather real-world cost and effectiveness data—important to investors because it can speed early adoption, stabilize initial revenue for the maker, and reduce commercial risk during the product’s launch.

value-based care medical

"Value-Based Care revenue decreased by 7% (+3% at constant currency, +3% organic1)..."

A health-care delivery approach that rewards providers for keeping patients healthy and improving outcomes instead of charging for each test or visit. For investors, it matters because it shifts where profits and losses come from—favoring providers and technologies that lower long-term costs, prevent complications, and demonstrate measurable results; think of it like paying a contractor only when the house stays sound, which changes who wins and loses financially.

ebitda financial

"The net leverage ratio (net debt/EBITDA) came in at 2.6x in Q1 2026..."

EBITDA stands for earnings before interest, taxes, depreciation, and amortization. It measures a company's profitability by focusing on the money it makes from its core operations, ignoring expenses like taxes and accounting adjustments. Investors use EBITDA to compare how well different companies are performing financially, as it provides a clearer picture of operational success without the influence of financial structure or accounting choices.

View in glossary

net leverage ratio financial

"The net leverage ratio (net debt/EBITDA) came in at 2.6x in Q1 2026..."

The net leverage ratio measures how much debt a company has compared to its available assets or earnings, after accounting for its cash and liquid assets. It helps investors understand how heavily a company relies on borrowed money to finance its operations and growth. A higher ratio indicates greater financial risk, while a lower ratio suggests a more cautious approach to borrowing.

form 6-k regulatory

"Our form 6-K disclosure provides more details."

A Form 6-K is a report that companies listed in certain countries file to provide important updates, such as financial results, corporate changes, or other significant information, to regulators and investors. It functions like an official company update or news release, helping investors stay informed about developments that could affect their investment decisions.

ifrs accounting standards regulatory

"Reconciliation of non-IFRS financial measures to the most directly comparable IFRS Accounting Standards..."

International Financial Reporting Standards (IFRS) are a set of common rules for preparing company financial reports so numbers like profit, assets and debt are presented consistently across countries. Think of them as a standardized recipe or blueprint that helps investors compare businesses the same way they would compare cars using the same list of features; consistent reporting reduces surprises and makes it easier to assess value, risk and performance.

non-ifrs financial measures financial

"Reconciliation of non-IFRS financial measures to the most directly comparable IFRS..."

Non-IFRS financial measures are company-reported numbers that modify or exclude items from standard accounting results so management can highlight what it sees as underlying business performance—common examples are adjusted EBITDA or adjusted earnings per share. They matter to investors because they can make trends clearer by removing unusual or noncash items, like cleaning lens smudges off a camera, but they require scrutiny since companies decide what to exclude and comparisons across firms may not be uniform.

dialysis clinics medical

"Fresenius Medical Care treated 289,923 patients in 3,539 dialysis clinics worldwide..."

Dialysis clinics are medical centers that perform regular treatments to filter a patient's blood when their kidneys can’t do so, using machines and trained staff to remove waste and excess fluid. They matter to investors because they provide an ongoing, necessity-driven service—similar to a subscription business—so patient volume, reimbursement rates from insurers and regulators, facility utilization and staffing levels directly affect revenue, profit and investment risk.

AI-generated analysis. How Rhea-AI works. Not financial advice.

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• Organic revenue growth¹ of 4% with growth in all operating segments
• Operating income² grew 10%, resulting in further margin expansion to 10.1%
• FME25+ transformation program related one-time costs mainly drove reported operating income decline of 14% and reported net income³ decrease of 22%
• Earnings per share² (EPS) increased by 16%, supported by the share buyback program
• FY 2026 outlook confirmed

BAD HOMBURG, Germany, May 5, 2026 /PRNewswire/ -- "Fresenius Medical Care delivered continued operational and financial progress in the first quarter, with organic revenue growth, improved profitability and adjusted EPS growth. Operating income growth was in line with our planned phasing," said Helen Giza, Chief Executive Officer of Fresenius Medical Care. "Care Delivery posted strong operating income growth supported by positive TDAPA effects. Excluding positive TDAPA effects, underlying Care Delivery operating income² improved by 6%. We are pleased with the speed of the rollout of our innovative 5008X CAREsystem, now available in around 100 clinics and with more than 100,000 treatments performed." Giza continued, "Through focused execution of our FME Reignite strategy, we remain on track to maintain Group operating income at a consistent high level while overcoming significant regulatory headwinds. We confirm our outlook for 2026 and are firmly committed to creating long-term value for our shareholders."

Key figures Q1 2026 (unaudited)

	Q1 2026	Q1 2025	Growth	Growth
	EUR m	EUR m	yoy	yoy, cc
Revenue	4,612	4,881	-6 %	+3 %
Operating income	286	331	-14 %	-9 %
excl. special items2	467	457	+2 %	+10 %
Net income3	118	151	-22 %	-21 %
excl. special items2	251	246	+2 %	+9 %
Basic EPS (EUR)	0.43	0.52	-17 %	-16 %
excl. special items2	0.91	0.84	+8 %	+16 %

yoy = year-on-year, cc = at constant currency, EPS = earnings per share

Progress on FME Reignite
Fresenius Medical Care, the world's leading provider of products and services for individuals with renal disease, successfully advances the next phase of value creation with its FME Reignite strategy. The strategy focuses on strengthening core operations, driving profitable growth and innovation, and advancing the company culture.

During the first quarter, the FME25+ transformation program delivered EUR 50 million additional sustainable savings. Fresenius Medical Care started the optimization of its U.S. dialysis clinic footprint by exiting 64 of up to 100 selected clinics. The company expects to retain the majority of its dialysis patients in neighboring clinics. FME25+ one-time costs, driven mainly by clinic closures cost, were treated as special items and amounted to EUR 166 million. The company expects EUR 250 million savings and EUR 350 million related one-time costs in 2026. FME25+ savings are expected to total EUR 1.2 billion by the end of 2027.

As part of the capital allocation framework, shareholder returns through dividends are complemented by share buybacks. Through an initial share buyback program of EUR 1.0 billion, 24.8 million shares or 8.5% of share capital were bought back in a significantly accelerated way. On April 30, the program was successfully completed in less than one year instead of within two years, as originally announced. As of March 31, 23.3 million shares or 7.9% of total share capital have been repurchased for a total investment amount of EUR 941 million.

Solid organic revenue growth driven by all operating segments  
In the first quarter 2026, Group revenue decreased by 6% compared to prior year (+3% at constant currency, +4% organic¹) to EUR 4,612 million. Significant currency effects negatively impacted revenue development in all three operating segments. Divestitures realized as part of the portfolio optimization plan negatively affected the revenue development by 50 basis points.

Care Delivery revenue decreased by 4% (+5% at constant currency, +6% organic¹) to EUR 3,294 million. Divestitures realized as part of the portfolio optimization plan negatively affected the revenue development by 80 basis points.

In Care Delivery U.S., revenue decreased by 4% (+6% at constant currency, +7% organic¹) to EUR 2,765 million. TDAPA reimbursement regulations as well as favorable rate and payor mix effects had a positive impact while exchange rates developed unfavorably. U.S. same market treatment growth came in at -0.4%.

In Care Delivery International, revenue decreased by 5% (-2% at constant currency, +3% organic¹) to EUR 529 million. The effects of closed or sold operations, mainly related to portfolio optimization, and unfavorable exchange rates were partially offset by positive organic growth¹. International same market treatment growth amounted to 1.3%.

Value-Based Care revenue decreased by 7% (+3% at constant currency, +3% organic¹) to EUR 490 million. The development in the quarter was driven by higher number of member months and positive effects from premium rates, offset by the changed risk contracting for one of the contracts and negative exchange rate effects.

Care Enablement revenue decreased by 5% (+1% at constant currency, +1% organic¹) to EUR 1,299 million. Unfavorable exchange rate effects as well as lower volumes, driven by negative impacts from volume-based procurement and stricter tender requirements in China, were partly offset by positive pricing and volume development outside China, mainly driven by the sales of 5008X CAREsystems.

Within Inter-segment eliminations⁴, revenue for services provided and products transferred between the operating segments at fair market value came in at negative EUR 471 million.

Continued earnings growth and margin expansion
In the first quarter 2026, Group operating income decreased by 14% (-9% at constant currency) to EUR 286 million, resulting in a margin of 6.2% (Q1 2025: 6.8%). Operating income excluding special items increased by 2% (+10% at constant currency) to EUR 467 million, resulting in a margin² of 10.1% (Q1 2025: 9.4%).

Operating income in Care Delivery decreased by 15% (-3% at constant currency) to EUR 271 million, resulting in a margin of 8.2% (Q1 2025: 9.3%). Operating income excluding special items increased by 12% (+26% at constant currency) to EUR 398 million, resulting in a margin² of 12.1% (Q1 2025: 10.3%). Compared to previous year, operating income development was driven by positive impact from TDAPA reimbursement regulations as well as positive rate and payor mix effects. The development was negatively impacted by higher personnel expenses. 

Operating income in Value-Based Care amounted to a loss of EUR 11 million, compared to a profit of EUR 3 million in the prior year, resulting in a margin of -2.3% (Q1 2025: 0.6%) Operating income excluding special items more than doubled with an increase of 113% (+137% at constant currency) to EUR 9 million, resulting in a margin² of 1.8% (Q1 2025: 0.8%). The improvement was driven by an enhanced savings rate and positive contributions from the FME25+ program.

Operating income in Care Enablement decreased by 7% (-9% at constant currency) to EUR 87 million, resulting in a margin of 6.7% (Q1 2025: 6.9%). Operating income excluding special items decreased by 1% (stable at constant currency) to EUR 113 million, resulting in a margin² of 8.7% (Q1 2025: 8.3%). Compared to the previous year's quarter, positive contributions from FME25+ program, the sales of 5008X CAREsystems as well as positive price and volume effects outside China contributed positively. This was offset mainly by unfavorable currency transaction as well as negative volume and price effects in China.

Operating income for Corporate amounted to a loss of EUR 40 million (Q1 2025: loss of EUR 81 million). Operating income excluding special items amounted to a loss of EUR 32 million (Q1 2025: loss of EUR 12 million). This development was mainly driven by the planned cost of the strategic IT platform investments.

Net income³ decreased by 22% compared to prior year (-21% at constant currency) to EUR 118 million in the first quarter 2026. Net income excluding special items increased by 2% (+9% at constant currency) to EUR 251 million.

Basic earnings per share (EPS) decreased by 17% compared to prior year (-16% at constant currency) to EUR 0.43 in the first quarter 2026, based on 275,246,345 shares. Basic EPS excluding special items increased by 8% (+16% at constant currency) to EUR 0.91.

Significantly improved cash flow, net leverage ratio around lower end of target corridor
In the first quarter 2026, operating cash flow significantly increased by 39% to EUR 227 million (Q1 2025: EUR 163 million), resulting in a margin of 4.9% (Q1 2025: 3.3%). The operating cash flow development was mainly driven by favorable working capital development despite seasonality in invoicing.

Free cash flow⁵ increased by 94% to EUR 40 million in the first quarter 2026 (Q1 2025: EUR 21 million), resulting in a margin of 0.9% (Q1 2025: 0.4%).

Total net debt and lease liabilities slightly increased to EUR 9,790 million (Q1 2025: EUR 9,753 million). The net leverage ratio (net debt/EBITDA) came in at 2.6x in Q1 2026 (Q4 2025: 2.5x) and continues to be around the lower end of our 2.5x to 3.0x target band.

Patients, clinics and employees
As of March 31, 2026, Fresenius Medical Care treated 289,923 patients in 3,539 dialysis clinics worldwide and had 108,165 employees globally.

Outlook 2026 confirmed
In 2026, Fresenius Medical Care expects revenue growth to be broadly flat compared to prior year. The company expects operating income to remain on a consistent level, with a range between a positive and negative mid-single digit percent growth rate compared to prior year.

The expected growth rates for 2026 are at constant currency and excluding special items in operating income. The 2025 basis for the revenue outlook is EUR 19,628 million and for the operating income outlook is EUR 2,212 million.

Investor conference call
Fresenius Medical Care will host a conference call for analysts and investors to discuss the results of the first quarter today, May 5, 2026, at 2:00 p.m. CEST / 8:00 a.m. EDT. Details are available on the Fresenius Medical Care website in the "Investors" section. A replay and a transcript will be available shortly after the call.

Please refer to our statement of earnings included at the end of this press release and to the attachments as separate PDF files for a complete overview of the results of the first quarter 2026. Our form 6-K disclosure provides more details.

About Fresenius Medical Care:
Fresenius Medical Care is the world's leading provider of products and services for individuals with renal diseases of which around 4.5 million patients worldwide regularly undergo dialysis treatment. Through its network of 3,539 dialysis clinics, Fresenius Medical Care provides dialysis treatments for approx. 290,000 patients around the globe. Fresenius Medical Care is also the leading provider of dialysis products such as dialysis machines or dialyzers. Fresenius Medical Care is listed on the Frankfurt Stock Exchange (FME) and on the New York Stock Exchange (FMS).

For more information visit the company's website at www.freseniusmedicalcare.com.

Disclaimer:
This release contains forward-looking statements that are subject to various risks and uncertainties. Actual results could differ materially from those described in these forward-looking statements due to various factors, including, but not limited to, changes in business, economic and competitive conditions, legal changes, regulatory approvals, results of clinical studies, foreign exchange rate fluctuations, uncertainties in litigation or investigative proceedings, and the availability of financing. These and other risks and uncertainties are detailed in Fresenius Medical Care's reports filed with the U.S. Securities and Exchange Commission. Fresenius Medical Care does not undertake any responsibility to update the forward-looking statements in this release.

1	At constant currency, adjusted for certain reconciling items including revenue from acquisitions, closed or sold operations and differences in dialysis days
2	Adjusted for special items; growth rate at constant currency (if not stated otherwise); for further details please see the reconciliation attached to the press release
3	Net income attributable to shareholders of Fresenius Medical Care AG
4	The company transfers products from the Care Enablement segment to the Care Delivery segment at fair market value. Services provided by the Care Delivery segment for patients managed under the Value-Based Care segment are also provided at fair market value. The associated internal revenues and expenses and all other consolidation of transactions are included within "Inter-segment eliminations".
5	Net cash provided by / used in operating activities, after capital expenditures, before acquisitions, investments, and dividends

 

Statement of earnings
	Three months ended March 31,
in € million, except share data, unaudited	2026	2025	Change	Change  at cc
Revenue	4,612	4,881	-5.5 %	3.1 %
Costs of revenue	3,433	3,697	-7.2 %	1.6 %
Selling, general and administrative expense	749	751	-0.2 %	7.8 %
Research and development expense	38	43	-11.9 %	-7.6 %
Income from equity method investees	(41)	(48)	-13.6 %	-13.6 %
Other operating income	(158)	(141)	12.1 %	14.7 %
Other operating expense	305	248	23.5 %	31.8 %
Operating income	286	331	-13.6 %	-9.2 %
Operating income excl. special items1	467	457	2.2 %	9.8 %
Interest expense, net	79	81	-2.6 %	5.9 %
Income before taxes	207	250	-17.2 %	-14.1 %
Income tax expense	43	61	-30.0 %	-28.8 %
Net income	164	189	-13.1 %	-9.3 %
Net income attributable to noncontrolling interests	46	38	23.0 %	36.7 %
Net income2	118	151	-22.3 %	-21.0 %
Net income2 excl. special items1	251	246	1.7 %	8.5 %
Weighted average number of shares	275,246,345	293,413,449
Basic earnings per share	€0.43	€0.52	-17.2 %	-15.8 %
Basic earnings per share excl. special items1	€0.91	€0.84	8.5 %	15.7 %
In percent of revenue
Operating income margin	6.2 %	6.8 %
Operating income margin excl. special items1	10.1 %	9.4 %
1 For a reconciliation of special items, please refer to the table at the end of the press release.
2 Attributable to shareholders of FME AG.

 

Reconciliation of non-IFRS financial measures to the most directly comparable IFRS Accounting Standards financial measures for comparability with the Company´s outlook
	Three months ended March 31,
in € million, unaudited	2026	2025
Operating performance excl. special items
These items are excluded to ensure comparability of the figures presented with the Company's financial targets which have been defined excluding special items.
Revenue	4,612	4,881
Operating income	286	331
FME25+ Program	166	28
Legacy Portfolio Optimization1	12	24
Legal Form Conversion Costs	—	0
Humacyte Remeasurements	3	74
Sum of special items	181	126
Operating income excl. special items	467	457
Net income2	118	151
FME25+ Program	124	20
Legacy Portfolio Optimization1	7	20
Legal Form Conversion Costs	—	0
Humacyte Remeasurements	2	55
Sum of special items	133	95
Net income2 excl. special items	251	246

1 2026: mainly related to costs associated with the 2025 divestiture of select assets of the Company's wholly owned Spectra Laboratories; 2025: mainly comprises severance payments and the impairment of goodwill resulting from the measurement of assets held for sale.

2 Attributable to shareholders of FME AG.

Media contact
Christine Peters
T +49 160 60 66 770
Christine.Peters@FreseniusMedicalCare.com 

Contact for analysts and investors
Dr. Dominik Heger
T +49 6172 609 2525
Dominik.Heger@FreseniusMedicalCare.com 

www.freseniusmedicalcare.com

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SOURCE Fresenius Medical Care Holdings, Inc.

FAQ

AI-generated questions and answers. How Rhea-AI works. Not financial advice.

What were Fresenius Medical Care (FMS) Q1 2026 revenues and organic growth?

Group revenue in Q1 2026 was €4,612m, with organic revenue growth of 4%. According to the company, currency effects and divestitures weighed on headline revenue while underlying organic growth was positive across segments.

How did FMS operating income perform in Q1 2026 and what drove the change?

Reported operating income fell to €286m, down 14%, while operating income excl. special items rose to €467m. According to the company, one-time FME25+ costs reduced reported income, while underlying performance improved.

What did Fresenius Medical Care report about EPS and shareholder returns in Q1 2026?

Basic EPS excl. special items increased to €0.91, while reported basic EPS was €0.43. According to the company, a €941m share buyback repurchased 23.3m shares, supporting EPS progression.

What is the status of the 5008X CAREsystem rollout and clinical uptake?

The 5008X CAREsystem is available in about 100 clinics with over 100,000 treatments performed. According to the company, the rollout in the U.S. is progressing at speed and contributing to Care Enablement sales.

How did the FME25+ program affect FMS Q1 2026 financials?

FME25+ delivered €50m of sustainable Q1 savings but caused €166m of one-time costs in the quarter. According to the company, total 2026 one-time costs are expected around €350m with €250m expected savings.

Did Fresenius Medical Care change its 2026 outlook after Q1 results?

No material change: the company confirmed its 2026 outlook for broadly flat revenue and operating income roughly in a positive-to-negative mid-single-digit percent range. According to the company, outlook figures exclude special items and are at constant currency.