DaVita (NYSE:DVA) executives told investors the company closed 2025 with fourth-quarter results “in line with our expectations,” pointing to accelerating revenue per treatment and improving performance in its Integrated Kidney Care (IKC) programs, while also noting higher-than-expected health benefit costs and continued pressure on treatment growth tied to elevated mortality.
On the company’s fourth-quarter 2025 earnings call, CEO Javier Rodriguez and CFO Joel Ackerman also provided 2026 guidance that calls for adjusted operating income growth at the midpoint and a sharp increase in adjusted earnings per share, driven by operating performance, a lower share count from buybacks, and the absence of further losses from DaVita’s investment in Mozarc after cumulative losses have already been recognized.
Clinical focus: outcomes in IKC and initiatives to improve mortality
He also cited “more than 10% improvement” in treatment adherence with fewer mistreatments and said the outcomes translate into “a better quality of life with fewer hospitalizations.”
Looking ahead, Rodriguez described near-term headwinds that include continued pressure on treatment growth driven by elevated mortality and a revenue-per-treatment impact from the expiration of enhanced premium tax credits for exchange plans. He said the company is pursuing targeted initiatives aimed at improving care and supporting higher treatment volume growth, including:
- Vaccination efforts: Rodriguez said DaVita is working to return to flu vaccination rates above 90% after historically achieving that benchmark for patients and clinical teammates. He said vaccinated patients early in the season showed a 9% lower hospitalization risk and 27% lower mortality risk versus unvaccinated peers.
- GLP-1 adoption and adherence: He said the company is working with physicians to help patients navigate “clinical, operational, and financial complexities” of GLP-1 drugs, citing evidence the drugs can reduce cardiac events and mortality for many dialysis patients.
- Advancing dialysis technologies: Rodriguez highlighted innovations such as medium-cutoff dialyzers and hemodiafiltration, which he said can help clear a broader range of toxins and show promise of reducing mortality “by as much as 20% or more.”
- Elara Caring partnership: DaVita announced a strategic clinical partnership with home care provider Elara Caring to create an ESKD-focused offering spanning skilled home health, personal care, and hospice, designed to lower hospitalizations and mistreatment rates and improve patient experience.
In response to a question about returning to at least 2% volume growth, Rodriguez said it is “a clinical story,” arguing that industry peak growth coincided with improving mortality. He said benefits from the company’s clinical initiatives could begin to appear in approximately two years, with the “full effect” by around 2029.
Fourth-quarter and full-year 2025 performance
Ackerman reported fourth-quarter adjusted operating income of $586 million, bringing full-year adjusted operating income to $2.094 billion. Adjusted earnings per share from continuing operations were $3.40 for the quarter and $10.78 for the year. Free cash flow was $309 million in the fourth quarter and just over $1 billion for the full year.
In U.S. dialysis, treatments declined about 20 basis points versus the fourth quarter of 2024. Ackerman said total patient census growth was as expected, but the timing was “back-end loaded” in the quarter. For full-year 2025, U.S. treatments declined 1.1% versus 2024, consistent with expectations discussed on the prior quarter’s call.
Revenue per treatment (RPT) increased sequentially by approximately $12 in the fourth quarter. Ackerman attributed the improvement to several factors: resolution of aged receivables, normal rate increases and improved yield, a slight improvement in private pay mix after a dip in the third quarter, and seasonal impacts tied to flu vaccines. Full-year RPT was approximately $410, up 4.7%. Ackerman also cautioned that the first quarter typically faces a $5 or more RPT headwind from higher patient responsibility amounts early in the year.
Patient care costs per treatment rose by approximately $6 sequentially, primarily from seasonal increases including health benefit costs and higher supply costs. Patient care costs per treatment ended the year 5.9% higher than 2024, “near the top end” of the revised range, but lower than original guidance. Ackerman noted about half of the year-over-year increase was from binders in the bundle.
Segment updates: International and IKC profitability
International adjusted operating income was $21 million in the fourth quarter and $114 million for full-year 2025. Ackerman said the results reflected strong performance with positive organic growth and integration of recent Latin America acquisitions. Later in the call, management said it generally expects international growth to be “half M&A and half organic,” with margins improving through leverage of fixed overhead and continued contribution of about a point to operating income growth, including in 2026.
IKC delivered its first profitable fiscal year, a milestone Rodriguez said came “slightly ahead of schedule” versus the profitability path discussed at the company’s 2021 Capital Markets Day. IKC adjusted operating income was $46 million in the fourth quarter and $22 million for the year. Ackerman said results reflected strength across all three IKC businesses and that final reconciliations of 2024 performance drove higher-than-expected shared savings revenue.
Pressed on what drove the better reconciliation results, Rodriguez pointed to the shared savings component, citing cumulative improvements such as medication management, transitions of care, segmentation of patient populations, earlier access to patients, and new interventions and protocols. Management added that as IKC matures, operating income improvement may moderate; the company expects incremental IKC operating income growth of $20 million in 2026.
Capital allocation, Elara investment, and leverage
DaVita repurchased 2.7 million shares in the fourth quarter and another 1.7 million shares after quarter-end. For full-year 2025, the company repurchased nearly 13 million shares for approximately $1.8 billion. Ackerman said a portion of repurchases typically comes from Berkshire Hathaway under a publicly filed repurchase agreement designed to keep Berkshire’s ownership at or below 45%.
At year-end, the leverage ratio was 3.26 times consolidated EBITDA, down from the third quarter and within the company’s target range of 3 to 3.5 times.
On the newly announced Elara Caring transaction, Ackerman said DaVita signed an approximately $200 million minority investment alongside a majority investment from Ares Private Equity Funds to acquire Elara Caring. After closing, expected mid-year, management expects the investment to contribute positively to DaVita’s other income line. Rodriguez said the investment thesis includes both financial return discipline and operational benefits for patients, noting roughly a quarter of DaVita’s population uses home health and that specialized kidney protocols could reduce hospitalizations, readmissions, and mistreatments.
2026 guidance: flat treatments, RPT headwinds, and higher EPS
For 2026, DaVita guided to adjusted operating income of $2.085 billion to $2.235 billion, representing 3.2% growth at the midpoint. Adjusted EPS guidance was $13.60 to $15.00, which management said reflects 33% growth at the midpoint. Free cash flow is expected to be $1.0 billion to $1.25 billion.
Ackerman said U.S. dialysis treatment volume is expected to be approximately flat versus 2025, assuming a flu impact consistent with the 2023–2024 season. The company is not assuming improvement in non-flu mortality, and it expects admissions to look similar to 2025 excluding the cyber incident impact. DaVita also added a table of normalized treatment days by quarter in its press release, and Ackerman noted a year-over-year normalized treatment day headwind in the first quarter of 2026 that should lead to negative year-over-year treatment volume growth in Q1.
For RPT in 2026, DaVita forecast growth of 1% to 2%, driven primarily by typical rate increases. Management expects an estimated $40 million headwind from the expiration of enhanced premium tax credits for exchange plans, largely offset by elimination of a $45 million RPT headwind in 2025 tied to the cyber incident. On the call, management reiterated that the cyber incident’s $70 million headwind included $25 million related to volume, much of which they said recurs because the lost census does not return in 2026.
DaVita expects total U.S. dialysis costs to rise 1.25% to 2.25% in 2026, driven mostly by wage increases and G&A investments, partially offset by lower depreciation and amortization. At the midpoint, the company expects U.S. dialysis adjusted operating income to rise about 1.5%, with IKC and international each contributing roughly 1% to enterprise adjusted operating income growth.
Below the operating line, Ackerman guided to approximately $10 million of positive other income in 2026, reflecting no further Mozarc losses. Debt expense is expected to decline by $20 million to $40 million year over year due to lower rates and refinancing activity. The company expects non-controlling interest to be about 16% of U.S. dialysis operating income and an effective tax rate of 24.5% to 26.5%.
Management also addressed the exchange-related headwind cadence, stating an approximate $40 million impact in 2026, $70 million in 2027, and $10 million the year after that, while noting open enrollment appeared more resilient than forecasted and that payment behavior would be an important variable to watch.
About DaVita (NYSE:DVA)
DaVita Inc (NYSE: DVA) is a leading provider of kidney care services, specializing in the management and operation of outpatient dialysis centers for patients with chronic kidney failure and end-stage renal disease. Headquartered in Denver, Colorado, the company offers a comprehensive suite of treatment modalities, including in-center hemodialysis, peritoneal dialysis, and home dialysis therapies. In addition to its core dialysis services, DaVita provides patient education, nutritional counseling, vascular access management and related laboratory services to support kidney health and overall patient well-being.
Since its formation in the mid-1990s through a clinical management services spin-off, DaVita has expanded both organically and through strategic partnerships and acquisitions.
