Q2 FY2026
Filed Aug 3, 2026Fresenius Medical Care accelerates income growth to 23% in the second quarter of 2026 while advancing its strategic agenda
Organic revenue growth was 5%, adjusted operating income grew 23% at constant currency and the adjusted operating margin expanded to 11.7%. Reported net income declined 3%, while Care Enablement adjusted operating income declined and the company reaffirmed rather than raised its FY 2026 outlook.
Key metrics
as reported| Metric | Value | q/q | y/y |
|---|---|---|---|
| Revenueother | EUR 4,861 million | – | 1 % |
| Revenue at constant currencyother | EUR 4,861 million | – | 4 % |
| Organic revenue growthother | 5% | – | 5% |
| Operating incomeother | EUR 466 million | – | 10 % |
| Operating income at constant currencyother | EUR 466 million | – | 15 % |
| Operating income marginother | 9.6% | – | – |
| Operating income excluding special itemsnon-GAAP | EUR 569 million | – | 20 % |
| Operating income excluding special items at constant currencynon-GAAP | EUR 569 million | – | 23 % |
| Operating income margin excluding special itemsnon-GAAP | 11.7% | – | – |
| Net income attributable to shareholders of Fresenius Medical Care AGother | EUR 218 million | – | -3 % |
| Net income attributable to shareholders of Fresenius Medical Care AG at constant currencyother | EUR 218 million | – | 3 % |
| Net income excluding special itemsnon-GAAP | EUR 303 million | – | 13 % |
| Net income excluding special items at constant currencynon-GAAP | EUR 303 million | – | 17 % |
| Basic EPSother | EUR 0.81 | – | 6 % |
| Basic EPS at constant currencyother | EUR 0.81 | – | 13 % |
| Basic EPS excluding special itemsnon-GAAP | EUR 1.13 | – | 24 % |
| Basic EPS excluding special items at constant currencynon-GAAP | EUR 1.13 | – | 28 % |
| Operating cash flowother | EUR 860 million | – | 11% |
| Operating cash flow marginother | 17.7% | – | – |
| Free cash flowother | EUR 625 million | – | remained stable |
| Free cash flow marginother | 12.9% | – | – |
| Total net debt and lease liabilitiesother | EUR 9,902 million | – | 6% |
| Net leverage ratio (net debt/EBITDA)other | 2.6x | remained stable | – |
| H1 2026 revenueother | EUR 9,473 million | – | -2 % |
| H1 2026 operating incomeother | EUR 752 million | – | -1 % |
| H1 2026 operating income excluding special itemsnon-GAAP | EUR 1,036 million | – | 11 % |
| H1 2026 net income attributable to shareholders of Fresenius Medical Care AGother | EUR 336 million | – | -11 % |
| H1 2026 net income excluding special itemsnon-GAAP | EUR 553 million | – | 8 % |
| H1 2026 basic EPSother | EUR 1.24 | – | -4 % |
| H1 2026 basic EPS excluding special itemsnon-GAAP | EUR 2.04 | – | 16 % |
| H1 2026 operating cash flowother | EUR 1,087 million | – | 16% |
| H1 2026 free cash flowother | EUR 665 million | – | 2% |
Segments
| Segment | Revenue | q/q | y/y |
|---|---|---|---|
| Care DeliveryTDAPA reimbursement regulations, favorable rate effects and lower implicit price concessions had a positive impact, while divestitures and exchange rates developed unfavorably. | EUR 3,478 million | – | 3% |
| Care Delivery U.S.TDAPA reimbursement regulations, favorable rate effects and lower implicit price concessions had a positive impact while exchange rates developed unfavorably. U.S. same market treatment growth came in at -0.9%. | EUR 2,897 million | – | 3% |
| Care Delivery InternationalDriven by positive organic growth. International same market treatment growth amounted to 0.8%. | EUR 581 million | – | 3% |
| Value-Based CareDriven by a higher number of member months and a positive effect from premium rates, partially offset by the changed risk contracting for one of the contracts. | EUR 536 million | – | 6% |
| Care EnablementPositive pricing and volume development outside China, mainly driven by sales of 5008X CAREsystem, were partly offset by volume-based procurement and stricter tender requirements in China. | EUR 1,371 million | – | 2% |
| Inter-segment eliminationsRevenue for services provided and products transferred between the operating segments at fair market value. | negative EUR 524 million | – | – |
2026 outlook
- Revenuerevenue growth to be broadly flat compared to prior year
- NoteOperating income excluding special items is expected to remain on a consistent level, with a range between a positive and negative mid-single digit percent growth rate compared to prior year.
- NoteThe expected growth rates for 2026 are at constant currency and excluding special items in operating income.
- NoteThe 2025 basis for the revenue outlook is EUR 19,628 million and for the operating income outlook is EUR 2,212 million.
- NoteThe company expects EUR 250 million savings and EUR 350 million related one-time costs in 2026.
- NoteFME25+ savings are expected to total EUR 1.2 billion by the end of 2027.
Capital returns
- Upon successful completion of the initial share buyback program on April 30, all 24.8 million repurchased shares were cancelled, thereby reducing the share capital by 8.5%.
- On May 26, a second program for a total volume of around EUR 1 billion (excluding ancillary costs) was announced and is being executed in tranches within 12 months.
- The first tranche was initiated on May 28 and is planned to end by December 15, 2026.
- As of June 30, 2,454,945 shares or 0.9% of total issued shares have been repurchased for a total investment amount of EUR 94 million.
What drove it
- Group revenue increased by 1% compared to prior year, +4% at constant currency and +5% organic.
- Currency effects negatively impacted revenue development in all three operating segments.
- Positive rate effects, TDAPA reimbursement regulations and FME25+ savings drove Care Delivery operating-income improvement.
- During the second quarter of 2026, the FME25+ transformation program delivered EUR 67 million additional sustainable savings.
- The company successfully concluded the 2026 optimization plan of its U.S. dialysis clinic footprint by exiting around 100 clinics.
- 227 U.S. clinics converted to the 5008X CAREsystem, with more than 600,000 treatments.
- Around 10% of dialysis machines in Fresenius Medical Care clinics in the U.S. were replaced by the new system, against the full year target of around 20%.
Concerns
- Reported net income attributable to shareholders of Fresenius Medical Care AG decreased by 3% to EUR 218 million.
- FME25+ one-time costs, including clinic closures cost, amounted to EUR 42 million.
- Special items include EUR 71 million impacts from the recommended revocation of the TAVNEOS® marketing authorization, primarily an impairment of intangible assets recorded by Vifor Fresenius Medical Care Renal Pharma Ltd.
- Care Enablement operating income excluding special items decreased by 6% to EUR 111 million and its margin declined to 8.1% from 8.7%.
- Care Enablement faced inflationary cost increases, volume-based procurement and stricter tender requirements in China.
- Corporate operating income amounted to a loss of EUR 46 million, compared with a gain of EUR 7 million in Q2 2025.
- U.S. same market treatment growth came in at -0.9%.
What to watch
- Delivery of the 2026 target of around 20% of U.S. dialysis machines replaced by the 5008X CAREsystem.
- The profitability contribution in the second half of 2026 from higher network efficiency following the exit of around 100 clinics.
- Execution of the second share buyback program for a total volume of around EUR 1 billion (excluding ancillary costs).
- Care Enablement performance amid volume-based procurement and stricter tender requirements in China.
- Progress toward EUR 250 million savings and EUR 350 million related one-time costs in 2026.
Balance sheet and cash flow
- Operating cash flow increased by 11% to EUR 860 million (Q2 2025: EUR 775 million), resulting in a margin of 17.7% (Q2 2025: 16.2%).
- Free cash flow remained stable at EUR 625 million in the second quarter of 2026 (Q2 2025: EUR 628 million), resulting in a margin of 12.9% (Q2 2025: 13.1%).
- Total net debt and lease liabilities increased by 6% to EUR 9,902 million (Q2 2025: EUR 9,315 million).
- The net leverage ratio (net debt/EBITDA) remained stable at 2.6x in Q2 2026 (Q1 2026: 2.6x) and continues to be around the lower end of the 2.5x to 3.0x target band.
- In the first half of 2026, operating cash flow improved by 16% to EUR 1,087 million (H1 2025: EUR 938 million).
- In the first half of 2026, Fresenius Medical Care increased free cash flow by 2% to EUR 665 million (H1 2025: EUR 649 million).
Analysis
Fresenius Medical Care reported EUR 4,861 million of Q2 2026 revenue, up 1% year on year, with 4% growth at constant currency and 5% organic growth. All operating segments contributed to organic growth, but currency effects negatively affected all three operating segments and divestitures reduced Group revenue development by 50 basis points. Care Delivery grew 3% to EUR 3,478 million, Value-Based Care grew 6% to EUR 536 million, and Care Enablement grew 2% to EUR 1,371 million.
Profitability strengthened materially on the adjusted basis. Operating income excluding special items rose 20%, or 23% at constant currency, to EUR 569 million and the adjusted operating margin expanded to 11.7% from 9.9%. Care Delivery adjusted operating income increased 40% to EUR 527 million, supported by rate effects, TDAPA reimbursement regulations and FME25+ savings. Reported operating income increased 10% to EUR 466 million, but reported net income attributable to shareholders declined 3% to EUR 218 million. Basic EPS excluding special items increased 24% to EUR 1.13, while basic EPS increased 6% to EUR 0.81.
Care Enablement remains an important offset to the Care Delivery improvement. Its reported operating income increased 11% to EUR 99 million, but operating income excluding special items decreased 6% to EUR 111 million and the adjusted margin declined to 8.1% from 8.7%. Pricing, volume and 5008X CAREsystem sales outside China were positive, while inflationary costs, volume-based procurement and stricter tender requirements in China weighed on performance. Value-Based Care moved to EUR 17 million of operating income from a EUR 9 million loss, although the company noted that quarterly earnings volatility is inherent to the business model.
Cash generation was strong, with operating cash flow up 11% to EUR 860 million, principally driven by favorable working-capital development. Free cash flow was EUR 625 million versus EUR 628 million in Q2 2025. Total net debt and lease liabilities increased 6% to EUR 9,902 million, while the net leverage ratio remained 2.6x, around the lower end of the 2.5x to 3.0x target band. The company cancelled all 24.8 million shares from its initial buyback and had repurchased 2,454,945 shares for EUR 94 million under the second program as of June 30.
The company reaffirmed its 2026 outlook for broadly flat revenue growth and operating income excluding special items ranging from a positive to negative mid-single digit percent growth rate at constant currency. Execution priorities include scaling the 5008X CAREsystem, where 227 U.S. clinics had converted and more than 600,000 treatments had been performed, completing the clinic-footprint optimization benefits in the second half, and delivering the FME25+ savings plan. Investors should also track the EUR 42 million of Q2 FME25+ one-time costs and the EUR 71 million impact associated with the recommended revocation of the TAVNEOS® marketing authorization.
Management, verbatim
Fresenius Medical Care delivered another quarter of highly profitable growth, driven by solid organic revenue growth and improved profitability.
Helen Giza, Chief Executive Officer of Fresenius Medical Care
Care Delivery achieved strong operating income growth. Importantly, underlying operating income improved by 34% excluding the positive TDAPA effects, driven by rate improvements and benefits from revenue cycle management.
Helen Giza, Chief Executive Officer of Fresenius Medical Care
Operating income growth in the first half was in line with our planned phasing for the full year and we confirm our outlook for 2026.
Helen Giza, Chief Executive Officer of Fresenius Medical Care
Not in the filing
stated, not guessed- Accounting basis, including whether results are reported under IFRS, is not stated in the provided document.
- Gross profit and gross margin.
- Operating expenses.
- Tax rate.
- Diluted EPS.
- Cash and cash equivalents.
- Total debt excluding lease liabilities.
- Dividend amount, dividend payment date and dividend yield.
- Prior-quarter revenue, operating income, net income, EPS, operating cash flow and free cash flow.
- Q2 2026 segment revenue prior-year values.
- Q2 2026 segment operating-income margins for Inter-segment eliminations.
- Prior outlook for comparison was not provided.
AlphAI analysis generated from the company’s SEC earnings filing (Form 8-K Item 2.02, or Form 6-K for a foreign private issuer). Every figure was cross-checked against the filing text; consensus estimates, price targets and share-price reactions are not shown because they are not in the filing. AI-generated research, not investment advice.