Financial Data and Key Metrics Changes - Adjusted operating income for Q2 2025 was $551 million, and adjusted earnings per share were $2.95, with free cash flow at $157 million [16][15] - The company reaffirmed its guidance for adjusted operating income between $2.01 billion and $2.16 billion and adjusted earnings per share between $10.20 and $11.30 for the full year [14][15] Business Line Data and Key Metrics Changes - US treatments per day declined by 1.1% year-over-year, primarily due to a higher than expected mistreatment rate, which was influenced by the cyber incident [17][30] - Revenue per treatment (RPT) increased by approximately $4.5 compared to Q1, but was negatively impacted by the cyber incident and lower dispensing volumes of binders [18][19] - Patient care costs per treatment decreased by approximately $3.5 sequentially, attributed to higher treatment counts, improved labor productivity, and lower binder dispensing volumes [20][21] Market Data and Key Metrics Changes - The company anticipates a year-over-year decline in treatment volume of 75 to 100 basis points, revised from a previous estimate of down 50 basis points [17][18] - International adjusted operating income increased by $6 million compared to Q1, primarily due to a one-time benefit [21] Company Strategy and Development Direction - The company is focused on clinical innovation and improving patient outcomes through advanced technologies and pharmaceuticals, including new drug classes and next-generation devices [6][7] - The company is committed to maintaining operational excellence and cost control, which is expected to continue even as treatment volumes normalize [76][77] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about entering a new wave of clinical innovation that could improve patient care and outcomes [6][7] - The company acknowledged the ongoing impact of the cyber incident but believes that the effects on adjusted results will be limited moving forward [11][30] Other Important Information - The company repurchased 3.1 million shares during Q2 and an additional 2.7 million shares since the end of the quarter [23] - The company raised $1 billion in senior unsecured debt and repriced its term loan, reducing the spread by 25 basis points [23] Q&A Session Summary Question: How did census and treatments track following the cyber attack? - Management indicated that while there were initial challenges, operations have normalized since the incident, but mistreatment rates spiked unexpectedly [30][31] Question: Can you provide phosphate binder contribution to RPT and CPT in the quarter? - The RPT contribution was in the low eights, and CPT was in the high sixes, with lower dispensing volumes attributed to adherence issues rather than a mix problem [34][35] Question: How is the company maintaining guidance despite treatment growth challenges? - The company is managing costs effectively, particularly in labor, and has seen better-than-expected performance in international operations [41][42] Question: What is the reason for the elevated mortality rates? - Management believes the elevated mortality is a holdover from COVID, with delays in care and sicker patients contributing to the trend [71][72] Question: What is the expected impact of new technologies on patient care? - The company is actively monitoring and conducting studies on new technologies, with a focus on improving patient outcomes through better clearance of middle-sized molecules [90][91]

Financial Data and Key Metrics Changes - Adjusted operating income for the second quarter was $551 million, and adjusted earnings per share were $2.95, with free cash flow at $157 million [14][22] - The company reaffirmed its guidance range for adjusted operating income of $2.01 billion to $2.16 billion and adjusted earnings per share of $10.20 to $11.30 for the year [23] Business Line Data and Key Metrics Changes - US treatments per day declined by 1.1% year-over-year, primarily due to a higher than expected mistreatment rate, which was influenced by the cyber incident [15][16] - Revenue per treatment increased by approximately $4.5 compared to the first quarter, but was negatively impacted by the cyber incident and lower dispensing volumes of binders [17][18] - Patient care costs per treatment declined by approximately $3.5 sequentially, attributed to higher treatment counts, improved labor productivity, and lower binder dispensing volumes [19][20] Market Data and Key Metrics Changes - International adjusted operating income increased by $6 million compared to the first quarter, primarily due to a one-time benefit [21] - Integrated Kidney Care (IKC) had adjusted operating income of $26 million in the second quarter, benefiting from approximately $40 million of revenue expected to be recognized later in the year [21] Company Strategy and Development Direction - The company is focused on clinical innovation and improving patient outcomes through advanced technologies and new drug classes [6][14] - The management emphasized the importance of operational excellence and cost management to navigate challenges and maintain financial performance [22][76] Management Comments on Operating Environment and Future Outlook - Management expressed optimism about entering a new wave of clinical innovation that could improve patient care and outcomes [5][6] - The company acknowledged the ongoing impact of the cyber incident but believes the effects on adjusted results will be limited moving forward [11][52] Other Important Information - The company reported a leverage ratio of 3.34 times consolidated EBITDA, which is within its target range [22] - The management highlighted the need for better clearance of middle-sized molecules and increased patient adherence to medications as key areas for improving patient outcomes [46][70] Q&A Session Summary Question: How did census and treatments track following the cyber attack? - Management indicated that while there were initial challenges, operations have normalized since the incident, but mistreatment rates spiked unexpectedly [26][28] Question: What contributed to the lower dispensing volumes of phosphate binders? - The reduction was attributed to a decrease in the number of prescriptions rather than a mix issue, with some patients obtaining binders through other means [30][31] Question: How is the company maintaining operating income guidance despite treatment growth challenges? - The primary driver is cost per treatment, particularly labor dynamics in US dialysis, along with better-than-expected international performance [38][39] Question: What is the outlook for Integrated Kidney Care (IKC) in the back half of the year? - IKC is expected to be roughly breakeven for the first half of the year, with guidance for a negative $20 million in the back half [95] Question: What is the impact of the cyber incident on revenue per treatment? - The cyber incident affected revenue for treatments done in Q2 due to manual processes and delays, which are not expected to impact the second half of the year [51][52] Question: What are the expectations for patient care costs moving forward? - The main driver for performance is productivity, with improved retention and training effectiveness contributing to lower costs [79] Question: How does the company plan to address elevated mortality rates? - Management believes the elevated mortality is a holdover from COVID, and they are implementing strategies to improve patient outcomes gradually [70][72]