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We aim to develop an integrated environmental approach for the Fresenius Group and foster a balanced view across all functions with regard to relevant environmental aspects. In its business operations, the Fresenius Group is subject to numerous guidelines and regulatory requirements that must be applied and complied with at all times. We integrate national requirements into our internal guidelines, which are defined in ISO-based or ISO-oriented management systems.

Our approach

We aim to analyze our impact on the material environmental aspects in both the manufacturing and services areas, as the risks of financial or reputational costs linked to environmental litigation are expected to increase. Also, reducing in-process material is essential for many industries affected by growing natural resource scarcity. Dedicated monitoring of natural resource consumption and waste-generating activities can lead to lower costs and, in some cases, new business opportunities. This is why we assess trends and adapt our activities if deemed essential to support the sustainable, long-term growth of our business. In the section Progress and measures in 2021 we report on our progress and measures we have made in the reporting year. Information on risks can be found in the Group Annual Report 2021 in the Opportunities and Risk Report.

On a business segment level, the environmental management strategy is aligned to the respective business models. Since the requirements in our business segments differ, environmental management is decentralized. The common foundation of environmental management approaches in our business segments is the ISO 14001 standard. All segments have implemented local, regional, or global management systems to take into account the respective business models and adapt processes accordingly. The dedicated functions of the business segments monitor and control the environmental impact of their operations. They analyze environmentally relevant vulnerabilities, develop suitable standard procedures, and implement appropriate measures. They support their certified local entities in effective, directed environmental goal-setting, monitoring these goals as well as developing and implementing mandatory guidelines for all entities.

Certifications and commitment

The environmental commitment of our business segments is reviewed or certified by external partners and regulatory bodies. We are continuously expanding the number of sites certified to ISO 14001. In 2021, further entities were added on a Group level. Information on the various standards is provided for each business segment in this chapter.

The environmental management approach of the Fresenius Group is controlled by internal specialists or dedicated functions within the business segments. Relevant data is reported regularly, e. g., on a monthly basis, to identify deviations. If deviations occur, our specialists initiate a root cause analysis which is evaluated, and corrective or preventive actions are implemented where necessary. Regular internal audits, partially annually, support the verification of data and management approaches, both for certified and non-certified entities. In this way, we ensure that activities to protect the environment are in accordance with internal guidelines and regulatory provisions. The overarching ambition is to improve efficiency and coverage of our management systems, so as to ensure the effectiveness of the procedures and systems in place.

Fresenius Medical Care

Production sites, distribution centers, laboratories, and dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemo­ dialysis the membrane of the dialyzer – is used to clean a patient’s blood. clinics are subject to internal and external audits. This involves checking their compliance with environmental laws and regulations, certification requirements, and internal guidelines. Due to the COVID-19 pandemic, audits in 2021 took place virtually. In total, 25% of the production sites are certified according to ISO 14001 standard and 5% of the production sites have ISO 50001 certifications.

Environmental certifications Fresenius Medical Care

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Certification ISO 14001 ISO 50001
Production sites certified (%) 25 5

The environmental management of Fresenius Medical Care is described in this section; for energy management and emissions see chapter Climate protection – energy and emissions.

Fresenius Kabi

Fresenius Kabi has a matrix certification for both its global environmental management system and the energy management system; both systems are audited annually and certified by TÜV Rheinland. Fresenius Kabi continuously monitors certified organizations to ensure that they comply with the standard process guidelines that are binding for them. To this end, globally appointed auditors conduct regular internal audits of the organizations. Fresenius Kabi is working to implement the environmental management system according to the international standard ISO 14001 and the energy management system according to ISO 50001 at all manufacturing plants worldwide by 20261. To achieve the goal of implementing the management systems, the business segment has drawn up an ambitious implementation plan and is working systematically on its realization. By expanding the coverage of the management systems, Fresenius Kabi aims to continuously improve its environmental and energy performance. 40 Fresenius Kabi organizations are currently certified according to ISO 14001, and 3 additional manufacturing plants were certified in 2021. Further, 22 organizations are certified according to ISO 50001, and 4 additional manufacturing plants were included in the certification in 2021. Information on the environmental management of Fresenius Kabi can be found down below; for energy management and emissions see chapter Climate protection – energy and emissions.

1 Implementation will be concluded at all Fresenius Kabi manufacturing plants in 2026. The certification issuance from the individual certification companies may extend into the following year.

Environmental certifications Fresenius Kabi

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Environmental Standard ISO 14001 ISO 50001
Number of certified manufacturing plants 38 18
Certified manufacturing plants1 (%) 78 37
1 %-coverage of manufacturing plants according to implementation goal of the management systems.
Fresenius Helios

Fresenius Helios started the introduction of an environmental management system in accordance with ISO 14001 in Germany in 2020 and continued this process in 2021. The certification of all Helios clinics is to be covered by matrix certification in the coming years.

Implementation of the energy management system in accordance with ISO 50001 was completed at all Fresenius Helios sites in Germany by the end of 2020. The clinics of Helios Germany were audited up to the end of 2019 according to the EDL-G in compliance with DIN EN 16247. With the introduction of the energy management system according to ISO 50001 in 2020, the EDL-G will continue to be operated seamlessly.

At Helios Spain, two further hospitals were certified according to ISO 14001 in 2021. The total number is now 42 hospitals. The number of hospitals certified to ISO 50001 increased by 1 to a total of 7.

Environmental certifications Fresenius Helios

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Environmental Standard ISO 14001 ISO 50001
Number of certified locations    
Germany 01 89
Spain 42 7
Number of certified locations (%)    
Germany 0%1 100%
Spain 88% 15%
1 Implementation planned
Fresenius Vamed

In 2021, at Fresenius Vamed no new certifications according to ISO 14001 or ISO 50001 were performed. The number of facilities with appropriate certifications was unchanged, with 7 facilities certified to ISO 14001 and 76 certified to ISO 50001.

Environmental certifications Fresenius Vamed 

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Environmental Standard ISO 140011 ISO 500012
Number of certified entities 2 52
Number of certified entities (%) 100 79
1 Certification relates to the parent companies of the health care and technical service facilities.
2 Health care and technical service facilities included in environmental reporting.

Environmental management in the business segments

Fresenius Medical Care

As a large international company, Fresenius Medical Care recognizes its responsibility to protect the environment and use natural resources carefully. Therefore, the business segment tracks and analyzes environmental data generated by the dialysis clinics and production sites worldwide, including energy and water consumption levels. This helps the company to manage resources more effectively. Eco-reporting across regions and functions is facilitated by specific tools.

Responsibility for environmental management is shared between global and regional functions. The Global Manufacturing, Quality, and Supply division is accountable for sustainable operations in the production business. Responsibility for environmental protection in dialysis clinics lies with the respective management in the regions. In 2021, the company also set up a network of environmental experts to regularly exchange information and work together on environmental deliverables at a global level. This is an important step toward establishing global governance, with the aim of driving strategic environmental initiatives across the whole organization.

Fresenius Medical Care monitors national and international regulations concerning environmental issues on an ongoing basis so that internal policies, and manuals are up to date. The business segment has established internal environmental standards, which are complemented with external certifications if it adds value.

In 2021, Fresenius Medical Care rolled out a new digital tool at its production sites to improve the data quality and efficiency of its eco-reporting. At the dialysis clinics in Asia-Pacific, Fresenius Medical Care introduced the eco-reporting software that is already being used in dialysis clinics in the Europe, Middle East, and Africa region, and in Latin America. Manufacturing and clinic staff received the necessary training on these new solutions.

Life cycle assessments

To help understand the environmental impact of its products, Fresenius Medical Care also conducts simplified product life cycle assessments (Screening LCA) for selected products. These assessments identify the life cycle phase with the highest impact, and the processes and materials needed to focus on to improve the eco-performance of the products and services. Based on international guidelines and the requirements of ISO 14001 and IEC 60601-1-9 standards, Fresenius Medical Care calculates the environmental impact caused during each individual stage of a product’s life cycle. The IEC 60601-1-9 standard applies to efforts to reduce the adverse environmental impact of medical electrical equipment. Screening LCAs were used to assess most of the active medical device product lines and are gradually being extended to disposables. In addition, the business segment has conducted detailed comparative product life cycle assessments for important disposables. These follow the structure and requirements of ISO 14040/44 standards and compare the eco-performance of several of the acid concentrates and dialyzers.

Fresenius Kabi

The focus of the environmental management system at Fresenius Kabi is to improve environmental performance and prevent environmental incidents. Key opportunities are, e. g., reducing energy and water usage, as well as wastewater, waste, and emissions, in relation to production activities.

A manual for the respective management system and standard operating procedures provide the certified units with the framework for their local environmental or energy management system.

The local management reviews the environmental management system at least annually to ensure continued compliance with the applicable requirements and effectiveness of the systems, and to identify potential for improvement. These local reviews are consolidated, analyzed, and evaluated on an annual basis by Fresenius Kabi's global EHS (Environment, Health, and Safety) function. Appropriate corrective measures will be initiated if deviations from the requirements of the ISO 14001 or ISO 50001 management systems are identified. Based on the local management reviews, the global EHS function presents a global management review to the responsible members of Fresenius Kabi's Management Board and other relevant functions of the business segment. In addition, the global EHS function reports on a quarterly basis about Fresenius Kabi's environmental and energy performance with selected indicators and provides an update on the implementation of the ISO 14001 and ISO 50001 management systems.

Manufacturing sites must identify environmental protection measures associated with environmental aspects of their activities and services. This can relate to emissions into air, water, or soil, consumption of natural resources and raw materials, waste and wastewater, packaging, transport, or other local environmental impacts. Environmental impacts of organizations are evaluated and, where necessary, environmental protection measures are implemented and reviewed for effectiveness. In addition, using internal audits, Fresenius Kabi identifies further improvement opportunities and develops appropriate measures with locally responsible managers to tap that potential. During an audit, a review is conducted as to how environmental aspects have been evaluated by the respective organization and whether objectives have been set for significant environmental aspects. Objectives and respective measures are reviewed by the auditor during inspection tours or on the basis of monitoring records. This is carried out at certified sites in particular. In addition, internal audits cover preparedness for emergencies including heavy weather events, floods, earthquakes, or hurricanes, depending on relevance or location. The frequency of global internal audits depends on audit observations from previous audits, environmental incidents, certification status, or the evaluation of the management review and can vary between one and four years. Global internal audits are conducted by the global EHS department. Due to the ongoing COVID-19 pandemic in 2021, most audits have been conducted remotely.

Fresenius Kabi has implemented mandatory environmental guidelines worldwide, which provide the framework for environmental protection in all Fresenius Kabi's organizations. The guidelines include general principles on how to address and prevent environmental risks, as well as how to prevent environmental incidents. Fresenius Kabi also expects careful and responsible handling of nature and its resources from its suppliers; this is set out in the Suppliers’ Code of Conduct.

Fresenius Kabi has a reporting process for environmental incidents such as violations of environmental regulations, pollution caused by uncontrolled spills, or complaints from third parties. Environmental incidents are recorded internally and categorized into five levels – depending on the impact of an environmental incident. Environmental incidents are reported to the global EHS function by local managers. Where necessary, Fresenius Kabi immediately reports environmental incidents to the relevant authorities. Environmental incidents are analyzed to determine the cause and to prevent future incidents.

Fresenius Helios

The environment has a direct impact on health. As a hospital operator, Fresenius Helios therefore feels a responsibility to protect the climate and the environment. With its environmental management strategy, the business segment works to reduce the environmental impact of hospital operations. It is the aim of Fresenius Helios to control energy consumption, raise employee awareness of the environment, and with these measures, to improve the ecological sustainability performance of its hospitals in the long term.

In Germany, the Infrastructure business unit is responsible for the energy and environmental management strategy of Fresenius Helios hospitals. It supports hospitals in the central purchasing of products or services and in sharing best practice procedures, among others. The business unit reports directly to the Chief Operating Officer (COO) of the parent company Helios Health.

In Spain, environmental management is part of operational management and is carried out by the Quality Management department and by the local environmental management committees of the hospitals. In addition, these interdisciplinary working groups develop and promote environmental guidelines and support the hospitals in their implementation. The guidelines serve to raise environmental awareness and tackle climate change through optimized energy use. In addition, the management policy, which applies to Helios Spain as a whole, contains the following obligations: to protect and preserve the environment, to promote environmental initiatives, to apply environmental protection and conservation measures, and to comply with the applicable requirements.

Fresenius Vamed

Fresenius Vamed continuously monitors national and international regulations on environmental and climate protection. Internal principles, guidelines, and standard operating procedures are updated as necessary. The division also expects its suppliers to treat the environment and natural resources with care and responsibility; this is set out in the Code of Conduct for Business Partners. As part of the ESG component of variable Management Board compensation and together with the relevant Fresenius corporate functions, the responsibilities and processes for the environmental area of Fresenius Vamed were collected and recorded in an internal process documentation in 2021.

Our ambitions

GRI 305-3

Each business segment has its own approach to environmental management. We are currently developing key performance indicators (KPIs) at Group level to measure our environmental performance and the impact of Scope 3 emissions, as environmental management is a key aspect of the variable compensation of the Board of Management.  For more information, please refer to the Corporate Governance Report of the Annual Report 2021, section "Compensation Report”. Further, in February 2022, the Management Board implemented a climate target for the Fresenius Group.

Fresenius Medical Care set new climate targets in January 2022.

Fresenius Kabi constantly works to improve its environmental management and reduce negative impacts on the environment. Certified organizations set local targets to constantly improve their environmental and energy performance.

Fresenius Helios is evaluating the extent to which the share of renewable energies relative to total energy requirements can be increased at the German clinic sites. The business segment is also exploring opportunities to increase the proportion of energy generated in-house. In this way, it is continuously increasing its own energy generation quota through combined heat and power plants. Nine new combined heat and power plants were installed at Helios Germany in 2021.

At Helios Spain, a defined percentage of annual investments is targeted at improving environmental and energy performance through projects. The business segment has set itself ambitious overarching goals and defines the environmental targets for each hospital locally each year. Since 2020, clear targets have been in place to reduce electricity and gas consumption in all hospitals. Furthermore, in 2021 the business unit set itself comprehensive goals to raise environmental awareness, improve energy use, and document CO2 emissions in all hospitals. The infrastructure of the hospitals is to be analyzed, with a view to increasing their own generation of energy and improving their equipment.

Helios Spain’s hospitals operate an energy management system; seven of these hospitals are ISO 50001-certified and are working on annual improvements to achieve energy savings.

Fresenius Vamed continues to strive to evaluate its strategy on the basis of sustainability criteria and to identify performance indicators that will serve long-term strategic development.

Progress and measures in 2021

In 2021, the Fresenius Group initiated various measures and projects with a view to establishing an integrated environmental approach. In February 2022, the Group climate target was approved.

In addition, our business segments achieved progress on which we report in the following.

Fresenius Medical Care

In 2021, the business segment launched a Global Environmental Policy, which was approved by the Management Board of Fresenius Medical Care. It provides a framework for environmental management at a global level and will serve as a basis for developing improvement targets. It addresses how Fresenius Medical Care manages and monitors environmental impact. It also acts as a framework for other policies and manuals. In addition, the company introduced manuals and guidelines for global data and reporting environmental indicators related to energy, greenhouse gas (GHG) emissions, and water. These include guidelines on how to report information using the new digital eco-reporting tool. Furthermore, Fresenius Medical Care has included information on environmental standards in the mandatory employee training on the Code of Ethics and Business Conduct.

The company regularly identifies and evaluates environmental risks as part of its enterprise risk management. In 2021, Fresenius Medical Care used Task Force on Climate-related Financial Disclosures (TCFD) standards as guidelines in this process for the first time. Additional risk examples were added to the risk catalog and specific assessments were performed, for example concerning water stress and climate change vulnerability.

Fresenius Kabi

In 2021, Fresenius Kabi progressed with the roll-out of the environmental management system at the designated manufacturing plants. The global EHS function supports the local organizations in preparing and implementing the management system and certification according to ISO 14001.

In addition, in 2021, the business segment began to take sustainability criteria into account in decision-making processes for new projects, such as the development of products or capacity expansions.

Fresenius Helios

In addition to the centrally managed energy efficiency projects, some Helios hospitals are also implementing site-specific projects to improve their energy and environmental performance.

At Helios Spain, the stronger integration of environmental management at Group level is supported by specific targets set by the hospitals’ management in 2021. Furthermore, since 2015, the business unit has been part of the Clúster de Cambio Climático alliance, organized by Forética, a leading corporate network for sustainability and corporate responsibility in Spain and Latin America. The alliance meets three times a year to discuss a specific topic with experts and authorities, to evaluate the best climate-related practices in the private sector, and to promote exchange and transparency between companies.

Fresenius Vamed

As part of the ESG component of variable Management Board compensation, Fresenius Vamed reviewed and recorded responsibilities and processes, and defined strategies on the core topics of energy and water in 2021. Detailed contents and derived measures of these various developments can be expected to be reported in 2022.


Internal and external audits are used to identify potential for improvement at both local and global level and to take measures to continuously improve environmental performance.

Fresenius Medical Care

At Fresenius Medical Care’s production sites, the business segment is involved in local environmental projects that are reported as part of the global Green & Lean initiative. This initiative enables best practices to be shared across the organization. The objective is to reduce emissions, promote the efficient use of natural resources, and increase recycling rates. By the end of 2021, more than 100 projects were reported. They aimed at, for example, improving proceses and recycling. As a result of these projects, per year the company expects to save more than 20,000 MWh of energy (0.8% of its total energy consumption), prevent nearly 5,500 t of CO2 equivalent emissions (0.7% of its total Scope 1 and 2 emissions), save more than 220,000 m³ of water (0.5% of its total water consumption), and recycle or reuse roughly 700 t of waste.

Fresenius Kabi

In 2021, Fresenius Kabi, e. g., conducted a global internal audit at one entity in which employees were randomly chosen and interviewed about their awareness of the environmental policy, environmental objectives, and the entity’s environmental management representative. It was found that awareness of these aspects in the respective entity showed potential for improvement. As a result, corrective and preventive actions were initiated, such as more frequent employee communication to raise awareness.

The headquarters of Fresenius Kabi are audited annually by TÜV Rheinland with regard to ISO 14001 environmental management certification. In 2021, no observations were detected, confirming that the environmental management system is in line with the requirements of ISO 14001. The ongoing COVID-19 pandemic had no impact on the roll-out of the environmental management system according to ISO 14001 in 2021.

In 2021, Fresenius Kabi documented environmental incidents in its internal reporting system. Where necessary, local authorities were informed of the incidents immediately after an incident became known. Necessary measures were implemented to reduce the environmental impact of the respective incidents. Fresenius Kabi has also taken the environmental incidents at the affected sites as an opportunity to implement preventive measures, such as training courses, in order to avoid future incidents. No incident led to a severe impact on the environment, biodiversity, or the communities nearby.

Fresenius Helios

Helios Germany conducts internal and external energy audits at the hospital sites. As part of the monitoring process, the respective personnel is sensitized to potential savings and increasing energy efficiency as well as related measures. The effects on energy efficiency are regularly monitored and evaluated within the energy management system. This process is part of the continuous improvement according to the requirements of ISO 50001.

Helios Spain achieved the targets set for 2021 and expanded the existing matrix certification of ISO 14001 to further hospitals. In addition to the local ISO 14001 certification targets, the goal was to include all sites in Spain into the ISO 14001 certification.