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Responsibility

Responsibility

Our concept of responsibility begins with our business model: As we are in constant dialog with patients, employees and doctors, we always keep an eye on their needs. At the same time, we are expanding environmental management at our sites to limit the impact of our business on the environment.

We take responsibility for the environment

Environmental management is a key factor of our business success: It enables us to implement increasingly stringent environmental requirements and design our operational processes to use resources as efficiently as possible, thus saving on costs. It also increasingly supports our business divisions in creating added value for our customers with eco-friendly products and services. Lastly, it ensures that we as a company take our responsibility to the environment seriously.

Environmental management a top priority in all our regions

Our EMEA (Europe, Middle East and Africa), North America, Asia-Pacific and Latin America regions step up their environment-related activities from year to year. Due to our decentralized corporate structure, we implement our environmental management at a regional level, as we do for most of our other operating areas. The responsible environmental managers develop strategies, sometimes in cooperation with external consultants, to boost environmental protection at our production sites and clinics and promote environmental awareness among our employees. They also coordinate environmental audits carried out by external government agencies, institutions and our own auditors at our production sites and clinics.

The EMEA region

Environmental management is part of our integrated management system in the EMEA region. The German technical inspection association TÜV regularly checks compliance with the ISO 14001 environmental management standard at our Company headquarters, in our certified plants and at national clinic organizations in Europe. At the end of 2012, our seven largest European production sites (2011: also seven) and our medical product development were certified according to ISO 14001. Furthermore, we have now introduced the environmental management system in 13 national regions in Europe (2011: twelve).

In the year under review, we began to implement our second environmental program for the Europe and Latin America regions. Management has defined five strategic environmental objectives as a framework for the program. At its sites and clinics, Fresenius Medical Care aims to:

  • encourage environmental awareness and environmentally responsible behavior,
  • enhance knowledge relating to strategic and operational environmental issues,
  • increase the Company’s environmental performance, for example its eco-efficiency,
  • improve control of environmental risks,
  • ensure that environmental regulations are complied with.

Together with the respective business divisions, our environmental managers have derived a large number of environmental objectives from these points for the individual stages of the value chain, for example for research and development, our production sites, for logistics and our dialysis clinics. The managers of our production sites, for instance, are required to set targets to improve their environmental performance. Additionally they identify potential savings in raw materials, energy and water, and plan measures to achieve improvements. By 2015, for example, we intend to recycle or incinerate at least 85% of production waste in the EMEA region. This target had already been achieved or exceeded at five of our seven biggest certified production sites in the EMEA region by the end of 2012. In the year under review, we launched projects to reduce water consumption at three plants. Four plants implemented measures to cut energy consumption and two sites curtailed their use of raw materials. At the Schweinfurt plant, for example, we have slashed the electricity consumption of each dialysis machine by a total of 27% over the last six years thanks to a variety of individual measures. At our Serbian site in Vršac, we reduced plastic waste in the production of dialysis filters by around a fifth.

Led by our St. Wendel site, we intend to develop performance indicators for energy use and raw materials consumption in 2013 to verify the sustainability of our production processes moving forward. Only in this way can we identify untapped potential in a production process that has already been largely optimized. We also plan to install a gas turbine at the St. Wendel plant in 2013 to generate energy. Coupling electricity and heat production can significantly increase efficiency when using natural gas as a fuel.

From 2007 to the end of 2010, we successfully implemented our first comprehensive environmental program for our European facilities. The main goals of this were to develop more environmentally friendly products, to curb the use of resources such as energy and water at production sites and dialysis clinics, and to avoid waste. One project was an energy efficiency initiative at our largest European production sites, thanks to which we now save more than €1.5 M in energy costs per year. Another project involved developing and launching our e-con5 clinic software, which we use in our European dialysis centers to gather data on our eco-efficiency, such as our water and energy consumption and waste disposal. In Europe, 452 of our clinics now use e-con5 (2011: 405), and we are continuing to roll out the software to gradually build up a comprehensive environmental data management system throughout Europe and, since 2012, in Latin America. Thanks to e-con5, our country organizations are now able to compare the ecological efficiency of their clinics on a monthly basis and quickly identify potential for improvement.

North America region

For our product business in the U. S., we have established a formal certified program to review environmental and occupational safety standards, to which all production plants and laboratories are subjected on an annual basis. The audits monitor compliance with regulations from the U. S. Occupational Safety & Health Administration, the Department of Transportation and the Environmental Protection Agency in addition to state and local statutes. At the end of August 2012, Fresenius Medical Care North America received the “Safety in Excellence Award” for the 13th time from the U. S. casualty and property insurer CNA. This award honors the Company’s commitment to its employees’ health, to safety, damage prevention and risk control. The fact that absences due to work-related accidents have fallen significantly at Fresenius Medical Care is also acknowledged by the CNA.

Environmental management at our clinics is reviewed both internally and by federal agencies. One criterion is compliance with regulations for the disposal of medical waste. We have also begun to look at whether our clinics and production sites in the U. S. fulfill the criteria for certification according to the ISO 14001 environmental standard. The first certification process is set to begin in April 2013 at our plant in Livingston, California, and should be completed by the end of the year.

As in our other regions, both Company environmental management staff and external partners support our U. S. plants and clinics in making their procedures more environmentally friendly with recycling programs, for example. For some years now, we have been running a program to reuse medical waste containers in our clinics together with a specialist waste disposal partner. At the Ogden site, our largest production facility in the U. S., we recycle materials from different areas of the plant, including different types of plastics and cardboard. At our Walnut Creek plant, we are working with a recycling company specialized in separating and recycling medical and electronic devices. As a result, we reprocess approximately 5% of all components from old dialysis machines for use as spare parts. In 2013, we intend to launch a program to continue to step up the recycling of paper and cardboard at our U. S. clinics.

Since the end of 2010, we have been working with an external service company in the U. S. that records and documents energy and water consumption in all our dialysis clinics on an ongoing basis. This enables us to collect data on the consumption of resources in our dialysis centers according to uniform criteria so that we can better identify opportunities to further improve our energy efficiency in future. Other tasks performed by the service provider include checking and settling the corresponding energy and water bills and compiling analysis reports on subjects such as greenhouse gas emissions and our carbon footprint for an internal mailing list. In 2013, we will also produce a monthly energy consumption report for the region, allowing us to identify clinics with unusually high water, gas and/or electricity consumption. This will enable us to avoid unnecessarily high energy consumption in future.

We comply with internal regulations to ensure that the equipment, fixtures and furnishings in our clinic buildings and interiors in the U. S. are as environmentally compatible as possible. Accordingly, we use energy- efficient lighting and air-conditioning systems, as well as eco-friendly flooring and wall paint. We meet or surpass industry standards for the insulation of roofs, walls, doors and windows. When purchasing water treatment systems for dialysis, we also increasingly ensure that these use resources and energy efficiently. In 2011, the first clinic in the U. S. equipped by Fresenius Medical Care received environmental certification in accordance with the U. S. LEED standard. LEED stands for “Leadership in Energy and Environmental Design” and establishes regulations for resource conservation and sustainability in construction.

Asia-Pacific and Latin America regions

In the Asia-Pacific region, local government agencies regularly carry out inspections of our wastewater systems and energy consumption, among other things. In addition, a Fresenius Medical Care team conducts annual audits to examine to what extent production, logistics, laboratories and administration comply with Company regulations for resource efficiency and environmental protection, and identifies areas for improvement. To this end, the auditors also utilize data on electricity, gas and water consumption as well as on waste disposal, which is collected on an ongoing basis in our production plants. We have implemented several energy efficiency projects at our Changshu site in China since 2010. For example, we now use air from one of our production areas that is kept at a constant temperature for air-conditioning in the warehouse. In 2012, we also installed hot air curtains to keep heat inside the rooms and warehouses. Since 2011, we have also reused waste water from the reverse osmosis plant and carried out further work to improve the site’s pipeline system. In the area of production, we have recycled condensation water since 2012. Furthermore, we have separated and recycled materials such as paper, plastic and waste since 2011, thereby saving on disposal costs.

We also made further progress in the area of environmental management in the Latin America region. In the past year, we continued to train our staff in Columbia in environmental protection issues. This is essentially about raising their awareness of how they can contribute to environmental protection on a day-to-day basis. Our environmental department in Bogotá also initiated a “Green Day” for all employees with activities covering all aspects of environmental protection. In our clinics, for example, dialysis teams made a film on environmental protection at the workplace. Prizes were awarded for especially creative work. In addition, we continued the “Environmental Leaders” program in the past year; this involves training volunteers at the individual clinics who then go on to support the implementation of environmental projects. To raise awareness among staff of Fresenius Medical Care Columbia’s commitment to social responsibility, the environmental and HR departments – together with Fundación Fresenius (see “Commitment to patients’ quality of life” in this section) – issue a quarterly newsletter. In 2013, we intend to introduce a waste management plan at our head office to train employees to reduce solid waste and promote the issue of recycling. In the past year, production and the medical department also initiated an occupational health and safety campaign.

In Argentina, we continue to record water and energy consumption and the disposal of medical waste at all dialysis centers on an ongoing basis. Using the consumption data obtained, we were able to negotiate successfully with water suppliers and specifically investigate water loss through damaged pipes; we also stepped up water treatment. In Venezuela, we continued an environmental awareness campaign for our clinic staff on the subject of waste disposal and energy and water consumption in 2012. The disposal of medical waste has also been improved. In Brazil, we intensively monitor water and energy consumption and the generation of medical waste in our clinics. To save water, we increasingly recycle the water from hemodialysis using the reverse osmosis method. This offers huge potential as the blood purification solution comprises 95% water. In 2012, we implemented the project at seven further clinics, bringing the current total to 15.

Environmentally-friendly products and services

We are increasingly concerned with making our products and processes more environmentally-friendly. The aim is to provide our customers with added value by helping them save on costs or fulfill environmental requirements better.

Developing environmentally friendly products

Our research and development division is continuously striving to make our products and processes more environmentally compatible by employing new materials with improved environmental properties, pushing the development of new technologies that further reduce the resource consumption of our dialysis machines, and lastly by using energy and raw materials efficiently in production.

To enable us to improve and report on the Company’s environmental performance in the long term, it is essential to track and analyze the impact of our products and services on the environment over their entire life cycle (ecological audit). In the reporting year, we therefore initiated the “Comparative life cycle assessment” project, which links information on product design, resource efficiency in production, logistics and the use of the products in dialysis. Data sources include in particular internal environmental reports, product specifications and data from external ecological audit databases. The aim of this project is to calculate and compare the ecological performance of different product groups for dialysis concentrates. By doing this, we can highlight especially environmentally friendly products in dialog with our customers and provide substantiated product information on the environmental impact of the concentrates. Moreover, this information can be used in the development of new products. In future, ecological auditing will be expanded to include further products and product groups.

At our key production site for dialyzers in St. Wendel in Germany, for example, we reduced the quantity of rinse water used in manufacturing dialysis (membranes by 25% last year by feeding it back into the production process. A quarter of the rinse water is now reused with only the remaining three-quarters being replaced with fresh water. As a result, we were also able to reduce our energy requirements for treating contaminated rinse water by 25%, corresponding to annual savings of €150,000. The rinse water is used to clean residues of the solvent DMAC out of the freshly woven fibers for the dialysis membranes. The water and solvents are then separated again in a complex thermal process so that both can be reused in a closed cycle. The less rinse water has to be regenerated, the less thermal energy in the form of steam is required, and thus the greater the energy savings.

In addition to conserving natural resources, processing improvements enable us to achieve savings of more than €1 M per year.

Initiatives for ecologically sustainable dialysis

Achieving further reductions in the environmental impacts of dialysis treatment while maintaining resource and cost efficiency is one of our top priorities. In 2010, in collaboration with the German Energy Agency (DENA), we developed an environmentally friendly energy concept that takes into account the specific requirements of dialysis clinics. According to this model for a CO2-neutral dialysis clinic, the clinic uses eco-friendly power and heat supplies to reduce its greenhouse gas emissions by as much CO2 (carbon dioxide) as it produces due to energy consumption for dialysis, water treatment and other operations. On the basis of these findings, we devised a manual for the ecological construction and renovation of dialysis clinics in conjunction with the Anhalt University of Dessau in 2011. This provides our architectural staff in the various countries in the EMEA region (Europe, Middle East and Africa) with practical architectural and technical guidelines on how to implement the findings from the model, taking into account the special requirements of dialysis patients and clinical teams. This can be done, for example, by generating electricity with solar cells on the roof, recovering heat from dialysis wastewater, installing special heat insulation in the building shell, and placing the windows to use daylight as efficiently as possible.

Based on the concept of the CO2-neutral clinic and the manual, we opened an especially environmentally friendly dialysis clinic in Roccadaspide, Italy, in 2012. The new building has brought together two nearby Fresenius Medical Care dialysis clinics and, compared to them, uses only half as much water and around a quarter less electricity. A core aspect of the environmental protection work is the installation of state-of-the-art water treatment technology by Fresenius Medical Care: A special two-stage water treatment facility produces the ultra-pure water required to manufacture the dialysis solution with very low water consumption, and a control device ensures a highly efficient supply of the dialysis concentrate from large tanks. The wastewater is also completely reused. As a result, this clinic saves around 2.5 M liters of water per year – in a very dry area where water is urgently needed for agriculture. Lower energy consumption is also aided by economical LED lights, which give off more even and more pleasant light and are also easier to dispose of than the conventional neon tubes. Moreover, the building is well insulated and its heating and cooling are particularly environmentally friendly and free from drafts thanks to the air conditioning built directly into the floors with an integrated heat exchanger. Fresenius Medical Care is planning to build further environmentally friendly clinics in Europe in the coming years. Another “green” dialysis clinic is already in planning near Barcelona; it is also expected to share many attributes of a CO2-neutral clinic.

We will start monitoring the environmental status of our clinics in the first quarter of 2013. All dialysis clinics will undergo a self-assessment entitled “How green is your dialysis clinic?” and rate the extent to which key environmental protection measures have already been established on site. The questionnaire consists of 50 items on the subjects of clinic management, building management, energy and transportation, water and concentrates, waste, and materials. For example, clinics will be asked if they have people in charge of energy, water and waste management, whether environmental protection projects were carried out, whether the building is equipped with photovoltaic elements, sun protection blinds, and energy-efficient lighting and equipment, and to what extent the consumption of scarce resources is analyzed. This assessment has two benefits: Firstly, we gain an overview of the environmental status of our clinics, which we can use as a basis for the renovation and refurbishment of clinic buildings. Secondly, we can monitor the extent to which planned new buildings comply with defined minimum standards. In addition, clinic management and employees are likely to further hone their awareness of environmental aspects, generate suggestions for improvement and implement them.

We also continued our environmental initiatives with external partners in 2012, such as the “Go Green in Dialysis” project that we started jointly with the European Dialysis and Transplant Nurses Association/ European Renal Care Association (EDTNA / ERCA) in 2009. In September 2011, our environmental guidelines for dialysis specialists were published. These were developed as part of the “Go Green in Dialysis” project and are designed to support clinic employees in organizing the processes in the workplace in a more environmentally friendly manner. The official presentation of the guidelines at the EDTNA / ERCA annual conference met with great interest among conference participants. The guidelines have now been translated into another six languages.

In addition, together with EDTNA / ERCA, we will be presenting the Green Innovation Award for the first time in 2013. The ceremony will take place at the 42nd EDTNA / ERCA Conference 2013 in Malmo, Sweden. Prizes will be awarded for three ideas, best practices, projects or promising concepts from individuals or teams representing companies or institutions helping to promote or advance environmental protection in hemodialysis. A requirement for participation is that the benefit of the competition entry can be transferred to other projects and that it can be measured and is sustainable.

We take responsibility for our stakeholders

As a manufacturer and provider of life-sustaining medical products and services, Fresenius Medical Care has a special responsibility towards its stakeholders, especially its patients and business partners. We base our conduct towards them as well as our research and development processes on Company and industry standards and legislation. Moreover, we are committed to improving the quality of life of kidney patients – as a service provider in our clinics, as a member of and together with associations and as a company in society. In this way, we aim not only to meet our responsibilities, but at the same time strengthen our good reputation in the dialysis market.

As part of our environmental program in the EMEALA region, we also began in 2011 to merge the existing local occupational safety systems in our dialysis clinics into one centralized occupational safety management system certified to the BSOHSAS 18001 standard and to incorporate it into our integrated management system. In the year under review, we successfully tested the new occupational safety management system in two dialysis clinics. Building on this, we have drawn up a training concept to serve as a basis for staff courses geared to specific target groups from 2013 to accompany the launch of the occupational safety management system.

Initiatives to promote people’s health and well-being: Our quality policy

In the past year, we implemented our revised quality policy for the EMEALA region. It focuses on people within and outside our Company; our primary concern is their health and well-being. We have broken down our quality goals into different target groups, including patients, employees and our social environment.

  • Patients:
    We want to increase the life expectancy of people with kidney disease, liver failure and immunodeficiency and improve their quality of life.
  • Employees:
    We want to offer the best possible working conditions, win the long-term loyalty of qualified employees at our Company and promote their professional development.
  • Social environment:
    We want to fulfill our social responsibility, comply with safety standards and legal requirements and gear our actions to the Fresenius Medical Care code of conduct.

With the implementation of these goals we want to ensure that we uphold our corporate values, cultivate our corporate identity and our constructive dialog by improving our integrated management system on an ongoing basis.

Proper conduct towards patients and business partners set out in guidelinest

Fresenius Medical Care’s code of conduct provides the framework for responsible and correct conduct of our employees towards our patients and business partners in accordance with legal statutes; for more details on the code of conduct see German Corporate Governance Code and Declaration of Compliance. Among other things, it contains specific guidelines on conduct for management and employees in our clinics as well as in sales and marketing. These regulations cover matters such as billing products and services correctly, behaving fairly vis-à-vis the competition, and treating patients with respect and integrity. Our marketing and sales employees receive specific compliance training tailored to their field of activity.

Research and development geared to ethical standards

Whenever Fresenius Medical Care wants to launch a new medical device or pharmaceutical product, the Company is legally required to prove and extensively document the new device’s or product’s effectiveness and safety based on clinical studies. This means that it must be used with a group of patients in a clinical environment over a specified period. For purposes of comparison, one or more additional groups of patients are treated using existing state-of-the-art products and methods.

Our industry is subject to extensive guidelines and laws to ensure that no ethical principles are violated during such studies, that physicians and institutions carrying out studies on companies’ behalf are carefully selected based on their qualifications, and that scientifically accepted methods are applied. They include, for example, the declaration of the World Medical Association, which prescribes basic ethical principles for clinical research, EU regulations on pharmaceuticals such as Directive 2001/20/EC, the EU Medical Device Directive (MDD) and ISO standard 14155, which defines the criteria for clinical investigation and reporting in clinical research. Fresenius Medical Care’s clinical research is founded on these regulations and laws. In addition, we observe national laws and regulations such as the Pharmaceuticals Act (AMG) and the Medical Devices Act (MPG) in Germany, or the U. S. Food and Drug Administration (FDA) regulations. Our own Fresenius Medical Care Standard Operating Procedures combine these regulations with internal rules to ensure that clinical studies commissioned by us are carried out and documented properly. Before a study can even begin, our application must be approved by ethics committees in the relevant countries. Compliance with such regulations by manufacturers of medical devices and pharmaceutical products is an important precondition for publishing their research results in the scientific media.

We only use animal testing to obtain approval of new products and forms of treatment where this is prescribed by law. Such tests are carried out by third-party research institutes in recognized test laboratories, and are always first approved by an ethics committee for animal testing. As a matter of principle, our strategy is to avoid animal testing and to use alternative methods wherever possible.

Working for the good of our patients

As a dialysis company, our aim is to continuously improve the quality of life of kidney patients. We pursue this even beyond our core products and services through our involvement in various initiatives to promote an active, healthy lifestyle for dialysis patients, improve patients’ access to high-quality treatment and provide health information and education about chronic kidney failure.

Commitment to patients’ quality of life

Fresenius Medical Care cooperates globally with regional and national associations and institutions that champion the interests of dialysis patients. In addition, we develop our own initiatives to help patients lead a healthier and more active life. In the U. S., for instance, we sponsor the Renal Support Network, a charitable association by and for patients with chronic kidney failure, which aims at providing patients and their families with health information, giving them more confidence in their everyday lives and strengthening their initiative.

In Brazil, we provide financial and professional support to the Fundação do Rim, a charitable foundation committed to helping more than 200 young dialysis patients in the province of Rio de Janeiro. This organization works with authorities and the public to provide access to medication and kidney transplants for children and adolescents, and promotes the establishment of more pediatric dialysis units in hospitals. At the same time, it organizes special programs for young patients, such as exercise, art and music classes and therapy courses, and trains parents in how to deal with their children’s disease.

In Chile, we started an initiative in 2011 to help patients find work and coach them at their new jobs. Various employers have already provided around 100 jobs for patients with working hours that leave sufficient time for dialysis treatment.

In Columbia, we have set up our own foundation to promote the health and well-being of our patients other than through actual dialysis treatment. The Fundación Fresenius is financed by donations from industry, our employees and private individuals. We prepare regular reports to show how the funds are used. In 2012, for example, the foundation provided patients with a warm, healthy meal immediately after their dialysis treatment; for patients with a low income, this was often the only meal of the day. The foundation also offered free travel between their homes and the dialysis center for patients with disabilities or on a low income. In addition, a large number of patients took part in cultural and sporting events and craft courses organized by the foundation. The foundation provided patients on peritoneal dialysis who do not have adequate conditions at home for their PD treatment with aseptic tents, in which conditions are hygienic and stable for treatment. The foundation intends to continue these activities and programs in 2013. For example, it intends to offer a cooking workshop for the first time to show chronic kidney patients who do not yet require dialysis the importance of healthy nutrition.

According to their registration data, one in three patients in Argentina does not have the elementary school leaving certificate presented after seven years, which means that many patients have insufficient reading skills. The low level of education also limits patients’ quality of life: It makes it harder for them to find a job on an already tough employment market and amplifies the typical problems of living with dialysis, above all the need to comply with the treatment plan and take medication in a disciplined fashion. To offer these patients new opportunities and boost their initiative, we began a joint project with the Ministry of Education of Buenos Aires province in 2008: The ministry now sends teachers from its adult education program to seven of our dialysis clinics, while Fresenius Medical Care provides the teaching materials. In 2012, around 90 of our dialysis patients were taught by 14 teachers with the prospect of achieving their school-leaving certificate. By the end of 2012, 23 patients had attained this goal thanks to the project and five moved on to a higher level of education. The project’s initiators as well as teachers and students consider the program to be exceptionally rewarding.

In Argentina, 25% of our patients suffer from disabilities and 70% have problems finding paid or even unpaid work. For ten years now, Fresenius Medical Care has therefore been involved in the “ProHuerta” initiative (roughly translated as “pro kitchen garden”) by the Argentine Institute for Agricultural Technology and the Ministry for Social Development. When Argentina experienced a severe economic crisis in 2002, access to food was also restricted for many dialysis patients. That was when the idea came about to provide patients with seeds for various types of vegetables and gardening equipment sufficient for an area of around 100 square meters and to feed a typical Argentine family. Together with their relatives, patients took part in classes and learned how to plant their vegetables, care for them as they grow and finally harvest and prepare them. In 2012, the program reached half and therefore more than 4,500 of our patients; one in seven of our employees were also involved in the program. 87% of our dialysis centers are now “green centers”, which means that they distribute seeds twice per year (fall/winter and spring/summer seasons). In 2012, more than 5,000 seed kits were handed out to patients and employees for the first time. Patients are now also being provided with small livestock like chickens and small fruit trees.

Promoting knowledge and further education, improving patient care

Fresenius Medical Care organizes and supports scientific conferences with international nephrology experts as well as training programs for doctors and dialysis specialists worldwide, thereby helping to ensure quality in dialysis. This is especially important in regions where modern healthcare standards are still being developed. We also participate in projects aimed at encouraging young doctors to become interested in nephrology and promoting new talent in this area. In Brazil, for example, we have been supporting an initiative by the Brazilian Society of Nephrology. Every two years, medical students at the end of their training are awarded for research projects in which they have developed solutions that improve the prevention of chronic renal disease in the population.

We also take part in local projects to improve the care of dialysis patients. The Renal Research Institute, a joint venture between Fresenius Medical Care North America and a hospital in New York, is a partner of the Sustainable Kidney Care Foundation. This promotes projects in Tanzania, Africa, to give patients with acute kidney failure in regions without an existing supply structure access to dialysis treatment. Acute kidney failure frequently occurs there in connection with other severe diseases such as HIV or tuberculosis.

Raising public awareness

Fresenius Medical Care is also involved in raising the health awareness of the general public. In Taiwan, for instance, we organize an annual information event together with the national nephrology society and several hospitals with the aim of raising public awareness of a healthier lifestyle and promoting the early diagnosis of kidney disease.

In the past year, we also launched the “pre-ESRD” campaign in the U. S., with which we aim to draw media attention to the risk of kidney disease. The idea is intended to motivate people to pursue a lifestyle and diet that helps them to avoid kidney damage and completely prevent kidney failure as far as possible, and enable them to recognize the symptoms of kidney disease and ensure that it is treated in time before there is no alternative to dialysis. To this end, we offer information to the media on chronic kidney failure and interviews with our nephrologists.

As part of the World Kidney Day, we carried out a national information campaign in Argentina in 2012 to inform people about the negative impact of kidney disease as well as the connection between kidney and cardiovascular disease and diabetes. To this end, we organized public lectures and television interviews, distributed information material and offered diabetes and high blood pressure examinations free of charge. More than 1,500 people took part in these health screenings throughout the country and were given advice on the subjects of health promotion, disease prevention and chronic renal failure. In Argentina, more than 27,000 patients underwent dialysis treatment in 2012. One in ten of the country’s more than 40 M inhabitants showed first signs of chronic kidney failure and almost half of them were unaware of this. As a result, more than half of the patients receive their first dialysis treatment as emergency cases.

Our donations and emergency aid

We provide funds, dialysis machines and medical supplies in crisis situations and for institutions that need specific aid immediately. In May 2012, we delivered and installed dialysis equipment in the Emilia Romagna region in Italy at short notice after it had been struck by an earthquake. Our crisis teams were also at work in North America during the hurricanes in June, August and October. For more information see the chapter “Our dialysis services business”.

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