Fresenius Medical Care

Fresenius Medical Care achieved solid growth in 2019. We are working successfully to offer even more patients even better and more individual treatment options. The inte­gration of the NxStage product line has led to record growth in the number of home dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemo­dialysis the membrane of the dialyzer – is used to clean a patient’s blood. patients.

Fresenius Medical Care is the world’s leading provider of products and services for people with chronic kidney failure. Around 3.5 million patients with this disease worldwide regularly undergo dialysis treatment. When the kidney function of patients with this disease fails, dialysis takes over the vital task of cleansing the blood of toxins and surplus water. ­Fresenius Medical Care offers products and services along the entire dialysis value chain from a single source. In our global network of 3,994 dialysis clinics, we care for more than 345,000 patients. At the same time, we operate 45 production sites, to provide dialysis products such as dial­ysis machines, dialyzers, and related disposables. In addition, Fresenius Medical Care offers non-dialysis services, among others, in the field of Care Coordination.

Our strategy is geared towards sustainable growth. We aim to continuously improve the quality of life of patients with kidney disease by offering innovative products and treatment concepts of the highest quality. We have successfully launched our 4008A dialysis machine, specifically designed for emerging markets, in the important growth market of China.

Business development

Fresenius Medical Care’s sales increased by 6% (2% in constant currency) to € 17,477 million in 2019 (2018: € 16,547 million). Adjusted sales 1 increased by 8% (5% in constant currency) to € 17,329 million in 2019 (2018: € 16,026 million). Organic sales growth was 5%. Currency translation effects increased sales by 3%. They resulted, in particular, from the appreciation of the U.S. dollar against the euro.

Sales by region
€ in millions 2019 2018 Change Currency translation effects % of total Fresenius Medical Care sales
North America 12,195 11,570 5% 5% 69%
Europe / Middle East / Africa 2,693 2,587 4% 0% 16%
Asia-Pacific 1,859 1,689 10% 3% 11%
Latin America 709 686 3% – 18% 4%
Corporate 21 15 37% 1% 0%
Total 17,477 16,547 6% 4% 100%

1 2018 adjusted for divestitures of Care Coordination activities; 2019 adjusted for the adoption of IFRS 16 (“IFRS 16 effect”) and NxStage

The key financial data is presented in accordance with the presentation of Fresenius Medical Care. For a detailed reconciliation please see the Group Management report.

Sales of health care services rose by 5% to € 13,872 million (1% in constant currency). Sales of health care products rose by 10% to € 3,605 million (8% in constant currency).

In 2019, the reported operating result (EBITEBIT (Earnings before Interest and Taxes)EBIT does include depreciation and write-ups on property, plant and equipment. EBIT is calculated by subtracting cost of sales, selling, general and administrative expenses, and research and development expenses from sales.) decreased by 25% to € 2,270 million (-28% in constant currency). This corresponds to an operating margin of 13.0% after 18.4% in the previous year. Adjustments on accounts receivable in legal dispute paired with reduced patient attribution and a decreasing savings rate for ESCOs weighed on earnings. These effects were partially offset by the remeasurement effect of the fair value of the investment in Humacyte, Inc.

Adjusted EBIT 1 remained on the previous year’s level at € 2,296 million (-4% in constant currency). On an adjusted basis, the EBIT 1 margin fell from 14.3% to 13.2%.

Reported net income 2 decreased by 39% (-42% in constant currency) to € 1,200 million (2018: € 1,982 ­million). The adjusted net income 1,2 decreased by 2% in constant currency.

1 On a comparable basis: 2018 before special items and after adjustments; 2019 before special items (transaction-related expenses, gain related to divestitures of Care Coordination activities, expenses associated with the cost optimization program), adjusted for IFRS 16 effect, excluding effects from NxStage transaction

2 Net income attributable to Fresenius Medical Care AG & Co. KGaA

The key financial data is presented in accordance with the presentation of Fresenius Medical Care. For a detailed reconciliation please see the Group Management report.

Regional development

North America remained ­Fresenius Medical Care’s largest business region. In 2019, sales increased by 5% (0% in constant currency) to € 12,195 million (2018: € 11,570 million). Reported EBIT decreased by 33% to € 1,794 million (2018: € 2,665 million), with a reported EBIT marginEBIT marginEBIT margin is calculated as the ratio of EBIT to sales. of 14.7% (2018: 23.0%).

Sales by segment
€ in millions 2019 2018 Change
Health care services 1 13,872 13,264 5%
Health care products 2,3 3,605 3,283 10%
Total 17,477 16,547 6%
  • 1 Sales from dialysis services and Care Coordination
  • 2 Sales from dialysis products such as dialysis machines, dialyzers, and related disposables, and non-dialysis products
  • 3 Including sales generated by corporate functions of € 21 million in 2019 and € 15 million in 2018

The average revenue per treatment in the United States was US$ 352 in 2019, compared to US$ 354 in 2018. The average cost per treatment in the United States increased from US$ 289 in 2018 to US$ 296 in 2019.

In 2019, the business development outside of North America, in the business segments EMEA (Europe / Middle East / Africa), Asia-Pacific, and Latin America, was impacted by currency translation effects. Sales increased by 6% (8% in constant currency) to € 5,261 million (2018: € 4,962 million). Reported EBIT increased by 12% to € 820 million (2018: € 732 million). The EBIT margin was 15.6% (2018: 14.7%).

Acquistions / Divestitures

In 2019, Fresenius Medical Care further expanded its clinical network, worldwide. We have further reinforced our activities in China with new product launches.

With the acquisition of NxStage Medical, Inc. in 2019, we have strengthened our vertically integrated dialysis business, improving quality of care and clinical outcomes for dialysis patients. NxStage develops, produces, and markets an innovative product portfolio of medical devices for use in home dialysis as well as in the critical care setting. Fresenius Medical Care reported record growth in home dialysis and now treats more than 25,000 patients at home in North America.

Treatment quality

Again in 2019, physicians and clinical staff in our dialysis clinics offered patients the highest-quality treatment. Please see page 95 ff. of the Group Non-financial Report for further details on treatment quality.

Fresenius Medical Care by region
North America Europe /
Middle East /
Latin America Asia-Pacific Total 2019 Change 2019 / 2018
Dialysis clinics (December 31) 2,579 781 234 400 3,994 2%
Dialysis patients (December 31) 211,064 66,217 34,810 33,005 345,096 4%
Treatments 32,138,448 10,042,109 5,388,330 4,579,220 52,148,107 4%