Delivering on our 2025 commitments

We closed the year with solid revenue performance and strong operating income growth at the upper end of our outlook, despite a challenging market environment. Our operating margin increased from 7.9% at the end of 2022 to 11.3% in 2025 – firmly within the mid term margin band of 10% to 14% established at the start of our transformation. This improvement reflects strong business performance, accelerated FME25+ efficiency gains, positive regulatory impacts and favorable reimbursement effects.

I am also proud to share that FME25+ is on track to deliver an expanded target of € 1.2 BN in sustainable savings by 2027. Building on our original transformation program, the enhanced initiative has already exceeded expectations – achieving € 804 M in savings by year-end 2025, well above the initial € 500 M target set in 2023.

We further strengthened our financial position, bringing our net leverage ratio to 2.5x at the end of 2025 – the low end of our 2.5x to 3.0x target range and an improvement from 2.9x in 2024. Since 2022, we have reduced our net leverage ratio from 3.4x to 2.5x, reflecting consistent progress toward a more resilient balance sheet.

FME Reignite: Our 2030 strategy to unlock value

At our June 2025 Capital Markets Day, we launched FME Reignite – our five-year strategy to lead kidney care with exceptional care and innovation, with our ambition to deliver both industry leading outcomes and margins with above market growth.

FME Reignite is anchored in three pillars:

• Reignite the Core through continued operational excellence 
• Reignite Growth and Innovation by expanding market share and driving volume
• Reignite our Culture by empowering our people and strengthening our values. 

Across the company, we are already making progress.

In Care Delivery, we remain focused on quality and patient outcomes, while driving productivity and operational excellence and improving realized dialysis rates. We are concentrating on improving mortality, reducing missed treatments, and delivering an exceptional patient experience, supported by new innovative therapies.

In Value-Based Care, we continue to take responsibility for integrated care delivery. We are achieving improvements in key quality metrics, including optimal starts for chronic kidney disease patients transitioning to end stage renal disease. In October, we welcomed Tommy O’Connor as CEO of Interwell Health and Head of Value- Based Care.

In Care Enablement, we are accelerating profitable growth through commercial excellence, operational efficiencies, and innovation. The 5008X CAREsystem is a strong example of the differentiated pipeline that supports this ambition.

In line with FME Reignite, we introduced a disciplined new capital allocation framework focused on delivering stable and predictable shareholder returns. In June we announced an initial € 1 BN share buyback program over two years. By the end of 2025, we completed the first tranche, and in early 2026 we accelerated the second tranche, which is expected to conclude by May 2026. Under the new framework, we also plan to propose a dividend of € 1.49 for 2025, representing a 3% increase compared with 2024 and corresponding to a payout of 33% of adjusted net income – well aligned with our target payout ratio of 30% to 40%.

We have bold ambitions – and the science, products, processes, and people to deliver. With FME Reignite, we are well positioned to set new standards of care, drive profitable growth, and create sustainable value for patients, shareholders, and employees.

Setting a new standard of care and innovation

We operate from a position of strength in an essential area of healthcare, supported by strong demographic trends and the rising prevalence of chronic conditions such as hypertension and diabetes. Growing recognition of chronic kidney disease as a major public health priority is further increasing demand for our therapies and care models. As the need for kidney care grows, the ability to deliver high-quality, innovative care at scale is more important than ever. Our vertical integration, market leading positions, and industry defining innovation uniquely position us to lead. These advancements are already improving patients’ lives. The introduction of high-volume hemodiafiltration (HDF) therapy in the United States will support improved outcomes, lower mortality, reduce patient outflow, and decrease missed treatments.

A major milestone this year was the U.S. Food and Drug Administration clearance of the updated, HDF capable 5008X CAREsystem in May 2025. This allowed us to introduce the therapy in select U.S. clinics in the second half of the year and refine our plans for full commercial launch in 2026.

Our approach builds on the findings of the European Union-funded CONVINCE study, one of the largest randomized controlled trials evaluating high volume HDF. The study demonstrated a 23% lower risk of all cause mortality compared to high flux hemodialysis, with survival benefits emerging after just three months of treatment. Additional results included fewer cardiovascular complications, improved patient-reported energy levels, and enhanced overall quality of life.

Feedback from our U.S. introduction reflects these benefits. Patients report feeling better, with higher energy, improved sleep, and shorter post-treatment recovery times. Clinic staff note quieter, less stressful workflows supported by enhanced automation, enabling more efficient, patient centered care.

We are launching from a position of exceptional strength. In the United States, we hold nearly 90% market share for in-center dialysis machines. Of roughly 160,000 installed machines, 145,000 are Fresenius Medical Care devices, including 56,000 in our own clinics. At this scale, the transition to the 5008X CAREsystem will be the largest infrastructure upgrade in our company’s history. In 2026, we will convert approximately 20% of our U.S. installed base, train more than 7,200 nurses and technicians, and transition around 36,000 patients across 28 states.

While this launch represents a major step forward in dialysis therapy, we continue to invest in future innovation – from next generation devices and platforms to digital ecosystems that enhance patient experience and improve outcomes.

Our culture and leadership: the power of care

Achieving our FME Reignite ambitions requires exceptional talent and leadership. This year, we welcomed Joseph E. Turk as CEO of our Care Enablement operating segment and Charles Hugh Jones, MD, FRCP, as Global Chief Medical Officer. They succeed Dr. Katarzyna Mazur Hofsäß and Franklin W. Maddux, MD, FACP, who retired after distinguished careers. Joe and Charles bring deep expertise and leadership that will help guide our company into its next chapter.

As we Reignite our Culture, we are building a high performance, accountable organization guided by purpose and a shared commitment to collaboration, empowerment, and execution.

Our progress in 2025 positions us to enter 2026 with clarity and confidence. Even as macroeconomic pressures and geopolitical uncertainty continue to shape the environment, today’s Fresenius Medical Care is stronger, more focused, and well equipped to navigate complexity and seize the opportunities reshaping healthcare.

The power of care continues to inspire us. Kidney care is essential, and every day our more than 100,000 employees bring that purpose to life for the patients who rely on our care. Their dedication is the source of our impact. To our shareholders: thank you for your trust and support. It enables us to advance our mission, execute our strategy, and deliver sustainable, long term value. Together, we will move this company forward and continue creating value for you and all who depend on us.

Sincerely,

Helen Giza

Chief Executive Officer and Chair of the Management Board