IKC Clinical Outcomes and Profitability
Integrated Kidney Care (IKC) delivered superior clinical outcomes (IKC patients 35% more likely to start dialysis with permanent vascular access, costs 3x lower in first 180 days, >10% improvement in treatment adherence) and fewer hospitalizations; IKC reported its first profitable full year in 2025 (full year adjusted operating income $22 million; Q4 adjusted OI $46 million) and management expects an incremental $20 million of IKC operating income growth in 2026.
Strong Full-Year Financial Results
Full year 2025 adjusted operating income was $2.094 billion and adjusted EPS from continuing operations was $10.78; Q4 adjusted OI was $586 million and Q4 adjusted EPS was $3.40. Full year free cash flow exceeded $1.0 billion.
Ambitious 2026 Guidance
Company guided 2026 adjusted operating income to $2.085B–$2.235B (midpoint ~3.2% growth) and adjusted EPS to $13.60–$15.00 (management later cited a midpoint of $14.30, ~33% YoY increase); free cash flow guidance of $1.0B–$1.25B (midpoint $1.125B).
Revenue per Treatment Momentum and Full-Year RPT Growth
Revenue per treatment (RPT) accelerated sequentially in Q4 (up approximately $12 sequentially) and full year 2025 RPT was approximately $410, up 4.7% versus 2024.
International Segment Performance
International adjusted operating income was $21 million in Q4 and $114 million for full year 2025, driven by positive organic growth and integration of Latin America acquisitions; management expects international to contribute about 1% to enterprise adjusted OI growth in 2026.
Balance Sheet and Capital Allocation Discipline
Full year share repurchases totaled nearly 13 million shares for approximately $1.8 billion; Q4 repurchases 2.7 million shares plus 1.7 million repurchased since quarter-end. Leverage ratio at year-end was 3.26x consolidated EBITDA (midpoint of 3.0–3.5x target).
Elimination of Further Mozarc Losses and Strategic Investment
No further losses expected from Mozarc (cumulative losses recognized equal to investment), improving other income; announced ~ $200 million minority investment alongside Ares for Elara Caring, expected to contribute positively to other income and support home-based ESKD care to reduce hospitalizations and missed treatments.
Clinical Initiatives to Improve Outcomes
Management outlined targeted clinical programs (vaccination push—current ~80% vs target >90%; GLP-1 adoption/adherence; advanced dialysis technologies that may reduce mortality up to ~20%; Elara Caring partnership) intended to reduce mortality, missed treatments and support volume recovery over time.