2024 SASB Index

Health Care Delivery

(1) 10,666,711 GJ (3,1 million MWh)

(2) 43%

(3) 15%

For further information on energy management, see chapter "Climate Change"  in our Sustainability Statement.

Total Waste: 199,407 metric tons

Hazardous waste: 47,800 metric tons

Non-hazardous waste: 151,607 metric tons

Note: Reported waste figures do not exclusively cover medical waste but encompass all waste generated across our operations. Compared to our 2023 reporting, we have extended the scope of our waste disclosures for 2024 to include additional business areas. This expanded reporting aligns with our commitment to transparency and sustainability in waste management.

For an overview of our waste treatment methods, please see chapter "Resource Use and Circular Economy"  in our Sustainability Statement.

Fresenius Medical Care processes patients’ information in accordance with its Global Privacy Principles. We assess the scope, purpose and legal basis when handling data, featuring activities such as accessing, collecting, using, sharing, or transferring personal information. We actively inform our patients, employees, and customers about the data we collect, process, and disclose, and how we process their data. We also inform them about the legal basis for processing and their rights under applicable privacy laws, including the right to access and the right to data rectification.

For a description of policies and practices related to secure our patients’ health information and further data, see chapter "Protecting Data" in our Sustainability Statement.

Fresenius Medical Care did not incur monetary losses during the reporting period as a result of legal proceedings associated with data security and privacy, (meaning any adjudicative proceedings before a court, regulator, arbitrator or otherwise).

All relevant legal proceedings and related financial effects are disclosed in our Annual Report – Notes to the Consolidated Financial Statements.

In our dialysis clinics, we treat patients with all kinds of insurance status. In the United States, the insurance mix includes the federal health insurance programs Medicare and Medicaid, as well as private/alternative payors such as commercial insurance and private funds. 

For information on our efforts to expand access to high-quality care for more patients, see chapter "Patients"  in our Sustainability Statement.

The United States (US) dialysis services business does not permit controlled substances to be kept or administered in its outpatient dialysis units.  Nephrologists and other providers cannot prescribe controlled substances to be administered to patients as part of the dialysis treatment.

Fresenius Rx (located in the US) does not supply controlled substances.
Azura Vascular Care (located in the US) has policies and procedures consistent with all Controlled Substance Regulations found within the Center for Medicare and Medicaid Services (CMS), the Drug Enforcement Administration (DEA), and accrediting bodies. Azura’s internal and external medication management programs are comprehensive in terms of efficiency, meeting regulatory requirements, and keeping patients safe. Azura partners with a pharmacy consulting company to ensure compliant medication management.

In the dialysis services business outside of the US where controlled substances are permitted, prescription is strictly regulated and monitored according to local legislations. Most countries use controlled substances only as emergency treatment. (i.e. no prescription). We have established specific protocols to ensure the safe handling and storage of these medications. In those locations we ensure that the appropriate level staff is trained on the appropriate use, storage, and disposal of controlled substances as required by local/regional laws. Similarly, staff supports patients with substance abuse disorders where required by local/regional laws.

The Care Delivery patient-facing services business (e.g. the U.S. Fresenius Kidney Care’s in-center, home dialysis as well as Nephrocare, Fresenius Kidney Care in AP, Azura Vascular, FRx) follows the local laws and requirements governing pricing disclosures. The method of communication varies by country and includes written communication, website posting, and in-person consultation, as required.

We work with the insurer/payor to understand the patient’s payment responsibility. For self-pay, we work directly with the patient to provide estimates for what they will be responsible for.

The US Care Delivery patient-facing services business (e.g. Fresenius Kidney Care’s in-center, home dialysis as well as Azura Vascular, Spectra Labs, FRx) has two approaches. For insured patients, the business first submits a claim to the insurance provider. The insurance provider informs the business about what the patient is responsible for paying based on their plan. In the case of self-pay patients, the business can provide an estimate of price. 

For the patient facing services business outside of the United States (e.g. Nephrocare, Fresenius Kidney Care in AP), the company follows the pricing requirements outlined by the national health system in that country.

For the US Care Delivery patient facing services business (e.g. Fresenius Kidney Care’s in-center, home dialysis as well as Azura Vascular), the Company sets our pricing and certain pricing information is made publicly available.

For the patient facing services business outside of the United States (e.g. Nephrocare, Fresenius Kidney Care in AP), pricing for services is usually subject to local law and reimbursements.

For more information on reimbursements, see our form 20-F.

(a) For the total recordable incident rate, see chapter "Working for Fresenius Medical Care"  in our Sustainability Statement.

(b) We do not report the total recordable incident rate for contract employees. For further information on employee health and safety, see chapter "Working for Fresenius Medical Care"  in our Sustainability Statement.

For 2024, our total voluntary turnover rate is 15.9%, and our total involuntary turnover rate is 5.3%. The global* voluntary turnover rate for physicians is 6.0% and the involuntary turnover rate is 1.8%. For non-physician health care practitioners, the voluntary turnover rate is 17.1% and the involuntary turnover rate is 3.8%.

For information on recruitment and retention efforts, see our Sustainability Statement, chapter "Working for Fresenius Medical Care", our global career website, and our employee website. 

For information on nurses training programs, global career paths, and insights into the jobs of our clinical staff, see our Nephrocare website and our corporate website.

Fresenius Medical Care takes steps to ensure the continuous operation of our critical healthcare services through providing backup power systems. For our U.S. dialysis clinics, we have placed back-up built-in power generators in areas in the southeast which are most prone to hurricanes. For our EMEA, AP, and some U.S. dialysis, there is a requirement that back up and built-in power generators be available where required by law. Our ambulatory surgery centers, pharmacy, and lab businesses also have facility generators as standard.

Additionally, we strategically place mobile fleets of generators (through vendor relationships) geographically across the U.S. to fill gaps in power generators to ensure continuity that may occur during times of natural disaster or grid failure. 

As per our guidelines, these systems are regularly tested and maintained to ensure their readiness in emergency situations, such as natural disasters or grid failures.

To allow us to continue treating our patients in extreme conditions, we have developed an emergency response system.

We are actively adapting our business operations to address longterm physical risks such as water stress, drought stress, and heat stress through the development of a forward-looking water strategy. In the long-term, we are also preparing for the impacts of transitioning to a low-carbon economy by further adapting to circular trends through the development of a circular economy strategy.

Medical Equipment and Supplies

No fatalities have been reported in which a causal relationship with our products has been definitively established.

It is essential that our products and services are effective and reliable, and that they pose as little a risk as is possible to patients. Our standards for planning, conducting- and monitoring clinical studies help us enhance the quality and safety of our products. For further information on the safety of our products, see chapter "Product Stewardship"  in our Sustainability Statement.

To help us understand the environmental impact of our products, we conduct simplified product life-cycle assessments for selected products. These assessments identify the life-cycle phase with the highest impact and the processes and materials we need to focus on in order to improve the eco-performance of our products and services.

In 2023, we launched a Portfolio Sustainability Assessment to further evaluate the sustainability performance of our products and services, which continued in 2024. The assessment aims to provide greater transparency in relation to our portfolio's sustainability taking into account social, environmental- and economic contributions. It creates a basis for strategic portfolio decisions that systematically consider our sustainability impact. For further information on our Portfolio Sustainability Assessment, see chapter "Product Stewardship" in our Sustainability Statement.

Globally, we donate dialysis machines and medical supplies to organizations that require support. In 2024 we donated approximately 1.8 metric tons of devices and equipment reflecting a total value of around 34,400 €. We also donated approximately 4.1 metric tons of supplies reflecting a total value of around 69,000 €.

In the U.S., we return and reuse shipping materials (including ice packs, Styrofoam cooler, and cardboard boxes) that transport the erythropoiesis-stimulating agent (ESA) Mircera. Nearly 1,900 locations participate in this initiative. We estimate that around 60,000 shippers were returned and passed inspection for reuse, which results in a savings of about 670 metric tons, and nearly $2.7 (€2.6) million in gross savings. Through a program with Lexmark, our locations in the U.S. returned around 7,500 printer cartridges with a total weight of around 11.2 metric tons.

Finally, Fresenius Medical Care in the U.S. recycled 2,024 total machines (including mixers, 2008K, 2008T, Spectra, K2, K@Home) from its FKC clinics. In addition, Azura Vascular in the U.S. returned about 1,800 IVUS catheters to NEScientific for repurposing. According to NEScientific, the approximate weight of each is .5lbs per IVUS catheter.

Sourcing of mineral raw materials is an important aspect of our commitment to sustainable procurement.

We are subject to, and we are committed to comply with the provisions of Section 1502 of the U.S. Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act) relating to conflict minerals. As outlined in our Conflict Minerals Policy, we adopt standards in line with the Organization for Economic Co-operation and Development’s (OECD) Due Diligence Guidance for Responsible Supply Chains of Minerals from Conflict-Affected and High-Risk Areas.

We encourage our suppliers to foster similar commitments in their supply chain related to conflict minerals disclosures. Suppliers who are non-compliant with our Conflict Minerals Policy are reviewed for continued business.

For additional information, see our Conflict Minerals Policy Statement, the Conflict Minerals Report, and the chapter “Sustainability in the Value Chain”.

We had no monetary losses associated with formal legal proceedings associated with bribery or corruption in 2024. All relevant legal proceedings and related financial effects are disclosed in our Annual Report – Notes to the consolidated financial statements.

Our Code of Ethics and Business Conduct covers general compliance concepts and standards, including the expectation that all employees perform their duties in accordance with the Company’s purpose, global values, policy, the Code of Ethics and Business Conduct  and the law. The general principles in the Code of Ethics and Business Conduct are supported by policies that address specific situations in accordance with all applicable local laws, including interactions with health care professionals.