How did FMS's revenue and expenses trends shift in Q4 2024?

Fresenius Medical Care AG (FMS) exhibited notable shifts in both revenue and expense trends during Q4 2024, reflecting strategic initiatives and market conditions:

1. **Revenue Trends**:
- **Total Revenue**: FMS reported a total revenue of $5.26 billion for Q4 2024.
- **Organic Growth**: Despite a slight overall revenue decline, organic revenue grew by 2%, supported by both Care Delivery and Care Enablement segments.
- **Market Impact**: The US market remained muted due to elevated mortality rates, while international sales declined due to divestitures but showed organic growth.
2. **Expense Trends**:
- **Total Expenses**: The specific total expenses for Q4 2024 are not available, but the company's focus on cost management is evident in the FME25 program, which achieved additional savings of €64 million, totaling €173 million by the end of Q3 2024.
- **Operating Income Margin**: FMS improved its operating income margin to 9.8%, nearing the 2025 target margin band of 10% to 14%.
- **Divestitures Impact**: The divestiture of clinic operations in Curacao, Guatemala, and Peru negatively impacted growth by 330 basis points.
3. **Financial Performance**:
- **Net Income**: FMS reported a significant surge in net income attributable to shareholders, increasing by 153% to €213 million, with basic earnings per share rising by 153% to €0.73.
- **Operating Income**: Operating income climbed by 42.7% to €463 million.
- **EBITDA**: EBITDA increased by 6.5% to €828 million.
4. **Strategic Highlights**:
- **FME25 Program**: This program has contributed significantly to cost savings, with expectations to achieve around €200 million in savings for 2024, surpassing the targeted €100 million to €150 million.
- **Debt Reduction**: FMS successfully reduced its net financial debt and improved its net leverage ratio to 2.8, below the target corridor of 3 to 3.5 times net debt to EBITDA.

In conclusion, FMS demonstrated robust financial performance in Q4 2024, driven by strategic initiatives that focused on cost management and operational efficiency, despite facing challenges in market growth due to mortality rates and divestitures.