Annual Report 2025
Rejuvenate
In 2025, Fresenius entered the next phase of our #FutureFresenius strategy: Rejuvenate. Building on strong momentum, we have defined three priorities that guide our actions across the entire company. Discover how we are putting them into practice in the stories below.
Scroll downOur stories
Video message by our CEO
Letter to our shareholders
Rejuvenate means renewal and fresh momentum. We are expanding our innovation pipeline in many areas: through new molecules and licensing agreements in Biopharma; through new formulations in Nutrition; through the expansion of industrial manufacturing in MedTech; through investments in our production capacities and supply chains in Pharma; and through digitalization, AI, and robotics in our hospitals. This rejuvenation is already delivering results.
Michael Sen CEO
The year at a glance
Revenue1
€ 22,554 m
+7%2
EBIT1
€ 2,595 m
+6%3
Net Income1,4
€ 1,995 m
+16%3
EARNINGS PER SHARE1,4
€ 3.54
+16%3
NET DEBT / EBITDA1,5
2.7 ×
Operating Cashflow
€ 2,606 m
+5%
- 1 Before special items
- 2 Organic growth rate adjusted for accounting effects related to Argentina hyperinflation
- 3 Growth rate in constant currency and adjusted for Argentina hyperinflation
- 4 Net income attributable to shareholders of Fresenius SE & Co. KGaA
- 5 At average exchange rates for both net debt and EBITDA; pro forma closed acquisitions/divestitures, before special items, including lease liabilities, including Fresenius Medical Care dividend, net debt adjusted for the valuation effect of the exchangeable bond.
€ in millions |
|
2025 |
|
2024 |
|
2023 |
|
2022 |
|
2021 |
||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Revenue and earnings |
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||
Revenue1 |
|
22,554 |
|
21,526 |
|
20,307 |
|
21,532 |
|
19,969 |
||||||||||||||||||
|
3,693 |
|
3,614 |
|
3,319 |
|
3,315 |
|
3,353 |
|||||||||||||||||||
|
2,595 |
|
2,489 |
|
2,266 |
|
2,190 |
|
2,337 |
|||||||||||||||||||
|
1,995 |
|
1,749 |
|
1,543 |
|
1,729 |
|
1,867 |
|||||||||||||||||||
|
1,098 |
|
1,125 |
|
1,145 |
|
1,125 |
|
1,016 |
|||||||||||||||||||
|
3.54 |
|
3.11 |
|
2.74 |
|
3.08 |
|
3.35 |
|||||||||||||||||||
Cash flow and balance sheet |
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||
Operating cash flow1 |
|
2,606 |
|
2,474 |
|
2,131 |
|
2,031 |
|
2,589 |
||||||||||||||||||
Free cash flow before acquisitions, dividends and lease liabilities1 |
|
1,914 |
|
1,670 |
|
1,130 |
|
942 |
|
1,401 |
||||||||||||||||||
Free cashflow after acquisitions, dividends and lease liabilities1 |
|
1,285 |
|
1,679 |
|
188 |
|
-318 |
|
388 |
||||||||||||||||||
Cash conversion rate1 |
|
1.1 |
|
1.1 |
|
1.0 |
|
0.9 |
|
0.9 |
||||||||||||||||||
Total assets |
|
41,396 |
|
43,550 |
|
45,284 |
|
76,400 |
|
71,962 |
||||||||||||||||||
Non-current assets |
|
30,368 |
|
32,104 |
|
32,764 |
|
58,121 |
|
54,501 |
||||||||||||||||||
Equity4 |
|
19,762 |
|
20,290 |
|
19,651 |
|
32,218 |
|
29,288 |
||||||||||||||||||
Equity ratio4 |
|
48% |
|
47% |
|
43% |
|
42% |
|
41% |
||||||||||||||||||
Net Debt1 |
|
10,348 |
|
11,295 |
|
13,268 |
|
13,316 |
|
12,650 |
||||||||||||||||||
|
2.7 |
|
3.0 |
|
3.8 |
|
3.8 |
|
3.6 |
|||||||||||||||||||
|
1,393 |
|
1,035 |
|
1,346 |
|
2,015 |
|
1,635 |
|||||||||||||||||||
Profitability |
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||
|
11.5% |
|
11.6% |
|
11.2% |
|
10.2% |
|
11.7% |
|||||||||||||||||||
|
6.6% |
|
6.2% |
|
5.2% |
|
5.6% |
|
6.2% |
|||||||||||||||||||
Dividend per share in € |
|
1.057 |
|
1.00 |
|
– |
|
0.92 |
|
0.92 |
||||||||||||||||||
Employees (December 31)1 |
|
178,394 |
|
176,486 |
|
193,865 |
|
188,876 |
|
185,827 |
||||||||||||||||||
|
||||||||||||||||||||||||||||
Kicked off Rejuvenate phase with strong momentum!
Click on the section to see more
Reset
2022The first step of our journey was Reset: strengthening our focus on returns, driving structural productivity, and creating momentum for change across the organization.
Revitalize
2023-2024The next phase, Revitalize, focused on continuous portfolio optimization and building new growth verticals.
Rejuvenate
2025–2027In 2025, we entered the Rejuvenate phase. Our goal is to accelerate profitable growth along our strategic platforms while continuing to develop our portfolio with discipline and advancing future-oriented innovations.
This phase is guided by a clear paradigm that aligns the plans of our business units and functions across the company: Upgrade Core – Scale Platforms – Elevate Performance!
Reimagine
2030+With stronger capabilities and a clear strategic direction, we are positioning Fresenius to actively shape the future of healthcare.
Reset
2022The first step of our journey was Reset: strengthening our focus on returns, driving structural productivity, and creating momentum for change across the organization.
Revitalize
2023-2024The next phase, Revitalize, focused on continuous portfolio optimization and building new growth verticals.
Rejuvenate
2025–2027In 2025, we entered the Rejuvenate phase. Our goal is to accelerate profitable growth along our strategic platforms while continuing to develop our portfolio with discipline and advancing future-oriented innovations.
This phase is guided by a clear paradigm that aligns the plans of our business units and functions across the company: Upgrade Core – Scale Platforms – Elevate Performance!
Reimagine
2030+With stronger capabilities and a clear strategic direction, we are positioning Fresenius to actively shape the future of healthcare.
Over the past three years, we have successfully implemented our #FutureFresenius strategy and created a new Fresenius that is innovative, relevant, resilient, and adaptable. We have made tremendous progress with our strategic transformation to create #FutureFresenius. From the outset, we defined a clear roadmap with four phases: Reset, Revitalize, Rejuvenate and Reimagine.
Learn more about our strategy
Sustainability at Fresenius
Sustainability is a part of Fresenius’ corporate strategy. Our Sustainability Statement shows how we address environmental, social, and governance topics and manage the associated impacts, risks, and opportunities.
Find out moreEBIT is calculated by subtracting costs of revenue, selling, general, and administrative expenses, and research and development expenses from revenue.
Introducing Fresenius’ next transformation phase
Fresenius is a stronger, more focused, more innovative and more efficient healthcare company than three years ago. We have made tremendous progress with our strategic transformation to create #FutureFresenius. From the outset, we defined a clear roadmap with four phases: Reset, Revitalize, Rejuvenate and Reimagine. #FutureFresenius is not just another transformation – it is a multi-year strategy!
In 2025, we launched the next phase of our strategy with strong momentum: Rejuvenate. Despite a fast-changing macroeconomic and geopolitical environment, we moved forward with confidence – driven by our clear priorities and the collective effort across the entire company.
“Over the past three years, we have successfully implemented our #FutureFresenius strategy and created a new Fresenius that is innovative, relevant, resilient, and adaptable. At the same time, we have significantly bolstered our company’s economic strength.”
Three priorities define the Rejuvenate phase:
Upgrading our core
Scaling our platforms
Further elevating our performance
Ultimately, it is about bringing new products and innovations to market, staying closely aligned with patient needs and creating long-term value across the healthcare ecosystem.
How we strengthen our “Core” to deliver better care
“Upgrading our Core” means continuously advancing our core businesses – Fresenius Kabi and Fresenius Helios – across product pipelines, people and talent, technical operations and medical workflows. In short: we keep doing what we do best – but we do it even better.
What this means for Fresenius Kabi
With our products and services, Fresenius Kabi supports patients in critical moments – in the emergency room, the operating theatre or the intensive care unit. We hold leading global positions across all four business areas: Pharma, Nutrition, MedTech and Biopharma.
Alma’s Story: Why we keep doing what we do – but even better
Our positive impact becomes most tangible through patient stories. One of them is Alma, a Fresenius Kabi employee diagnosed with breast cancer while expecting a child. The medicines she once helped bring to patients supported her through chemotherapy, pregnancy and recovery – a powerful example of how scientific excellence translates into personal strength when it matters most.
“From chemo to my epidural, and even throughout my pregnancy, Fresenius Kabi products were there. That gave me strength and confidence.”
Across Pharma, we continued building on our strong heritage as a leading provider of high-quality medical products – including generics and IV solutions, which form the backbone of resilient healthcare systems. In 2025, we expanded our pharma portfolio with several product launches in the U.S. Around 70% of our U.S. portfolio consists of medicines listed on the FDA’s list of essential medicines – underlining our relevance in safeguarding supply.
Josh’s Story: Supporting independence at home
Through the 2025 Caring with Courage series – presented by the International Council of Nurses (ICN) and produced for them by BBC StoryWorks Commercial Productions – we highlighted how our portfolio supports independence and quality of life. Homecare nurses enable patients requiring complex therapies, such as home parenteral nutrition, to safely transition from hospital to home – empowering them to manage their health with confidence.
“One thing I really enjoy about the job is building that relationship with patients that I see regularly. You can feel quite vulnerable at home, so building up that trust is really important.”
In Nutrition, we further strengthened our position in enteral and parenteral nutrition. Five new enteral nutrition products were launched in 2025, reinforcing our ambition to deliver tailored clinical nutrition solutions that make a meaningful difference in patients’ daily lives.
Cannan’s Story: The power of plasma donation
Eight-year-old Cannan Caton lives with Common Variable Immune Deficiency (CVID), a rare immune disorder. To stay healthy, he relies on IVIG therapy – made possible only through plasma donation. Thanks to the generosity of donors and the therapies we help bring to life, Cannan is thriving.
“We make sure that Cannan is able to do everything a normal little boy should be able to do. IVIG is truly life-saving and life-giving.”
In MedTech, we continued leading in blood collection technologies, expanded our cell processing capabilities, and advanced infusion therapy with the rollout of our innovative Ivenix Infusion System.
What this means for Fresenius Helios
Fresenius Helios comprises Europe’s leading private hospital networks in Germany and Spain. With around 140 clinics and numerous outpatient facilities, we treat about 27 million people annually.
Excellence in patient care
Both Helios Germany and Quirónsalud are recognized as quality leaders.
Can you guess?
How many treatment cases in Germany exceeded the market-average quality performance in 2025?
In Spain, 13 Quirónsalud hospitals were listed among the World’s Best Hospitals 2025 by Newsweek, and more than 60 Quirónsalud doctors were recognized by Forbes España among the top 100 doctors in Spain.
What modern medicine can achieve today
In 2025, a highly specialized team at Helios Pforzheim saved the life of a premature baby born at 26 weeks and weighing just 490 grams. The successful diaphragmatic hernia surgery – rarely attempted at such an early stage – demonstrates what coordinated expertise and modern neonatal workflows can achieve.
“This case shows what modern medicine can achieve today – but above all, what is possible when a highly motivated team works together. We are proud of everyone involved.”
Upgrading our Core also means modernizing systems
In intensive care units across Helios Germany, anesthetic gas recycling systems reduced emissions by around 20% in 2025 while maintaining full clinical safety. This marks a concrete step toward more sustainable care and aligns with Fresenius’ new sustainability concept.
Regional clustering for better, faster, more precise care
Fresenius Helios rolled out its nationwide cluster model in Germany. By grouping hospitals and outpatient centers into regional medical ecosystems, Helios strengthens specialization, improves coordinated patient pathways and optimizes resources. Nearly all Helios hospitals now operate in clusters – ensuring consistent quality and rapid access to expertise across regions.
Innovation that closes critical healthcare gaps
As a system-critical healthcare company, Fresenius benefits from strong global trends: rising healthcare spending, increasing chronic diseases and the growing need for efficient, affordable and innovative solutions.
Click on each card to explore more details
Did you know?
Longevity Gap
disease-burdened life years
Longevity Gap
By 2030, 1.4bn people will be over 60; 84% of 67M deaths will be from chronic disease
Source: Global Burden of Disease, Institute for Health Metrics and Evaluation (2022)
Workforce Gap
healthcare worker shortfall
Workforce Gap
The World Health Organization estimates a projected shortfall of 10 million health workers by 2030
Source: WHO Health Workforce (2023)
Efficiency Gap
GDP on health expenditure
Efficiency Gap
Health expenditures will rise to more than 10% of global GDP by 2030
Source: OECD Health at a Glance (2019)
This is why the second priority of our Rejuvenate phase focuses on scaling three therapy platforms designed to deliver better outcomes for patients and payers:
Innovative (Bio)Pharma
Expanded MedTech
Digitized Care Provision
Scaling is not just about size. It is about relevant product advances, innovations to each platform and sustainable impact across the healthcare ecosystem as a whole.
What we need are the latest generation of affordable medicines for critical and chronic diseases, along with clinical nutrition solutions tailored to individual medical needs. Similarly, precise, targeted medical technology and holistic – and digitally enabled – care along the entire patient journey are equally essential.
Innovate (Bio)Pharma: Innovation and specialization
For (Bio)Pharma, this means innovation! We need to bring the latest generation of molecules and products to the market and keep filling the pipeline. Scaling (Bio)Pharma means accelerating innovation and continuously strengthening our pipeline across Pharma, Nutrition and Biopharma.
Biopharma is among the fastest-growing healthcare segments. Biosimilars make complex biological treatments more affordable and accessible, particularly in oncology and autoimmune diseases. Fresenius is expanding its biosimilar business to provide more patients with access to biological therapies.
Can you guess?
How large are the estimated annual savings across the EU and U.S. through biological treatments?
Source: Biosimilars Council and IQVIA reports
2025 marked an unprecedented year for our biosimilars portfolio, with two approvals and three launches. The growth of our Tyenne biosimilar and innovations such as the Otulfi autoinjector and Bomyntra – a biosimilar available in both a prefilled syringe and a vial – further strengthened our position.
Nathalie’s Story: Living fully with a chronic disease
Nathalie Oliveira, a longtime Fresenius Kabi colleague, lives with a chronic disease that ended her surgical career – but not her dedication to healthcare. Finding the right biological treatment was crucial in managing her fatigue and maintaining her quality of life.
Her story embodies our mission: enabling patients – and colleagues – to live fully, supported by the therapies we develop and deliver.
“Having a chronic disease should not stop you in your journey in life.”
Expand MedTech: Precise and smart technologies
For MedTech, this means expansion! Scaling MedTech means strategically expanding our device portfolio and integrating technologies more closely into emergency and surgical settings. Connectivity and digital integration are key: from devices to hospital management systems and enhancing digitalization to seize new opportunities and meet customer needs.
Strong partnerships to accelerate innovation
In neonatal intensive care, this commitment translates into supporting pioneering research for the most vulnerable patients: extremely premature infants. A joint research team in Rome is exploring an innovative transfusion approach for extremely premature newborns. Instead of using adult donor blood, which may release oxygen too rapidly and stress fragile tissues, the team is investigating the use of red blood cells derived from umbilical cord blood – naturally rich in fetal hemoglobin and potentially better suited to the physiology of these tiny patients.
Turning this vision into a scalable clinical study required advanced preparation processes and close collaboration. Fresenius Kabi contributed technical expertise, specialized equipment, and hands-on training for eight neonatal intensive care units across Italy. Together with leading physicians this partnership demonstrates how precise technologies, smart device integration, and strong clinical collaboration have the potential to open new pathways in patient blood management.
A further example of strengthened partnerships in 2025 is the European EASYGEN consortium. The aim: help transform CAR-T cell therapy to make innovative therapies more affordable and accessible in the future.
Digitize Care Provision: Digitally enabled & integrated care
For Care Provision, this means digitalization! The seamless use of digital technologies and AI throughout the entire patient journey improves the quality of care and reduces the workload on hospital staff. At Fresenius Helios, we want to harness these opportunities even more effectively.
Quirónsalud’s Jiménez Díaz hospital in Madrid
80
%of their treatment time through enhance digitalization.
Source: Example refers to oncology day hospital treatments by Quironsalud in the hospital Jimenez Diaz Madrid (FY/25 Investor presentation)
Next-level digital tools and AI for better patient care
Digitalization and AI continued to transform everyday clinical practice in 2025. Scaling our Care Provision platform means that we are steadily expanding digital technologies across our hospitals, leveraging our distinctive strengths: direct patient access, rich clinical data, and deep medical expertise. We are investing in AI and digital transformation to enhance clinical decision-making, streamline workflows, and elevate patient experience.
A prime example is our proprietary platform Casiopea, our digital health ecosystem, which today has ~9 million active users in Spain. Virtually all medical activities are now registered on this platform, creating a seamless and connected patient experience.
The AI-based large language model Scribe has now been used to document more than one million doctor-patient consultations. More than 5,000 medical professionals actively use the system, with consistently positive feedback — saving time and allowing physicians to focus more fully on their patients.
Advanced robotics and AI-supported diagnostics
Beyond this, we are rolling out a broad network of digitally and AI‑supported diagnostics, including radiological image data analysis, emergency care decision support or digital pathology. These initiatives make care smarter and more patient‑centric, improving outcomes and reducing treatment times. Our systems consistently deliver medical quality above market benchmarks.
The Ion robotic-assisted bronchoscopy system at Fresenius Helios lung cancer centers shows how advanced robotics are transforming hospital diagnostics. Using high-resolution imaging and software that creates a digital twin of the patient’s airways, physicians can precisely navigate to millimeter-small lung lesions that were previously unreachable. This innovation enables much earlier and more accurate detection of lung cancer, often before symptoms appear. As a result, hospitals can offer faster diagnoses, lower complication risks, and significantly improved chances for curative treatment.
“The new robotic system for bronchoscopy is a game changer. This allows us to reach the deepest lung tissue and can even reach millimetre-sized suspicious tissue compaction – and take samples. This was previously not possible endoscopically.”
These innovations underpin our quality leadership. Combined with best-in-class healthcare professionals and state-of-the-art hospitals, Fresenius Helios remains the top choice for patients seeking exceptional care.
Unlocking our full potential
2025 has been a tremendous year: disciplined execution, strategic clarity, and the collective strength of #TeamFresenius. Across the company, we delivered excellent operating performance and navigated macroeconomic volatility and a new geopolitical reality with confidence.
“Elevating Our Performance”, is about unlocking our full potential as ONE #TeamFresenius. It reflects our company’s mindset: moving forward with confidence, accelerating performance, and making Fresenius even more innovative and relevant. Only in this way can we remain a leading healthcare company in the future.
“We are confident – not because the environment is easy, but because we are prepared: with a clear strategy, a compelling portfolio, strong momentum, and a dedicated team.”
#CommittedToLife: Delivering on our promise
Everything we achieved in 2025 reinforces our commitment to saving and improving people’s lives. From scaling affordable medicines to advancing digital transformation and delivering consistently high quality of care - #CommittedToLife is the unifying promise behind our performance ambitions.
This high level of performance characterized Fresenius’ fiscal year 2025. We raised our guidance for revenue and EBIT growth and ultimately delivered on these ambitious targets. Building on strong momentum, we further strengthened our balance sheet while making targeted investments to prepare for the next growth phase.
The results for the full 2025 financial year are excellent across the board:
organic revenue growth1
EBIT growth2
Core EPS growth2,3
1Organic growth rate adjusted for accounting effects related to Argentina hyperinflation
2Growth rate at constant currency (cc) and adjusted for Argentina hyperinflation
3Excluding Fresenius Medical Care
Before special items
Laying the foundations: Shaping next-level therapies
Looking at 2026 and beyond, our focus is on building a resilient healthcare franchise for the future.
By Upgrading our Core and Scaling our Platforms, we are further increasing our performance and expanding our impact. Our strategy aims to position Fresenius in higher-growth healthcare segments and thereby drive sustainable value creation by unlocking new, previously untapped earnings potential.
We enter 2026 and beyond with:
A more resilient business model and stronger financial flexibility
A clear emphasis on product pipeline execution and rollouts, investing in innovation and R&D-driven differentiation
Strengthening supply chain resilience
Doubling down on our local for local approach
Continued acceleration of digitalization, AI adoption, and process optimization
Fresenius is in great shape! The foundations are set. And together, we will continue to elevate our performance even further - for patients, for partners, and for our shareholders.