DaVita Inc.

Second quarter adjusted operating income was $579 million, adjusted earnings per share was $4.02, and free cash flow was $256 million. U.S. dialysis treatments increased 56 basis points versus Q2 2025, and treatments per normalized day also increased 56 basis points. Revenue per treatment declined by approximately $2 sequentially, while patient care cost per treatment declined approximately $3 sequentially. Year-to-date revenue per treatment was 3.6% higher than the first half of 2025, and management still expects full-year 2026 RPT growth of 1% to 2%. Full-year 2026 treatment growth is now expected near the top end of the prior 25 to 50 basis point range, and total cost per treatment is still expected to grow between 1.25% and 2.25%. The company reaffirmed full-year 2026 guidance with a midpoint of $2.2 billion for adjusted operating income and $14.65 for adjusted EPS, and said it expects Q3 to be $50 million to $100 million lower than Q4, largely due to IKC timing.

Javier Rodriguez framed the quarter as evidence that DaVita’s strategy is gaining traction, citing improving patient outcomes, better-than-expected volume trends, and a more favorable clinical backdrop. He emphasized the success of the phosphate-binder transition, support for CMS’ direction on bundle policy, and the importance of middle-molecule clearance as a clinical platform for long-term growth. His tone was constructive and confident, especially around expanded HD, which he said DaVita can roll out quickly with secured supply and existing machines.

Joel Ackerman said the quarter’s financial performance was shaped by offsetting factors: better volume and lower mortality helped, but higher cost per treatment, lower commercial mix, and lower phosphate-binder revenue pressured results. He pointed to enterprise OI up about 5%, U.S. dialysis G&A growth of roughly 10%, and a leverage ratio of 3.37x consolidated EBITDA, within the 3 to 3.5x target range. He also noted $200 million invested in Elara Caring, $500 million of incremental debt issued and used primarily to repay revolver borrowings, and 2.2 million shares repurchased in Q2 plus 183,000 shares after quarter-end.

Analysts focused on why U.S. dialysis operating income was flat despite stronger treatment growth, with management pointing to elevated revenue-per-treatment pressure, higher cost-per-treatment growth, and G&A growth as the main offsets. Questions also centered on the source of volume gains, where management said the improvement was mainly mortality-driven rather than from new patient starts, and on the impact of commercial mix changes from ACA exchange enrollment, which they said should keep driving a roughly $40 million headwind this year. On expanded HD, management said the economics are not significant in 2026 and likely not until a mortality benefit appears later, which Joel Ackerman said would not be expected until 2028.