NephroPlus FY26: International mix lifts revenue per treatment as the network scales

Nephrocare Health Services Limited (NephroPlus) closed FY26 with a combination dialysis investors typically look for: volume growth, a rising revenue per treatment, and improving profitability. Revenue from operations rose to INR 998.8 crore in FY26, up 32.2% year-on-year. Adjusted EBITDA (excluding ESOP and Saudi-related expenses) increased to INR 238.1 crore, up 37.6%. Adjusted profit after tax rose sharply to INR 128.3 crore, up 74.6%.

The year’s operating story was anchored in higher dialysis sessions delivered. Treatments increased 16.6% to 38,44,658 sessions, while active guests at period end rose 11.8% to 36,981. Revenue per treatment moved up to INR 2,598 from INR 2,292, which management attributed to a higher international mix, favourable foreign exchange movements, and the full-year benefit of the Philippines reimbursement price increase that took effect in October 2024.

FY26 performance: growth driven by treatments and mix

NephroPlus framed dialysis as a scale-driven, fixed-capacity business. A clinic can generally run only a limited number of cycles per day, which means growth comes from ramping utilisation, adding machines where space permits, and opening more centres. FY26 outcomes reflect that model in action. Treatment growth outpaced guest growth, consistent with management commentary that treatment frequency tends to rise as patients progress through the disease.

The company also highlighted a meaningful shift toward overseas markets where realisations per treatment are higher. In the investor presentation, international revenue contribution increased from 31.8% in FY25 to 41.8% in FY26. This mix shift, combined with currency tailwinds, helped lift RPT even as the core delivery model remained largely unchanged.

Q4 FY26: revenue growth continued, margins impacted by a one-time provision

For Q4 FY26, revenue from operations was INR 265.6 crore, up 21.2% year-on-year, supported by a 15.2% increase in treatment volumes to 9,96,074 sessions. Adjusted PAT for the quarter was INR 35.1 crore, up 27.4%.

Adjusted EBITDA for Q4 FY26 was INR 55.4 crore, up 2.6% year-on-year, but the adjusted EBITDA margin dropped to 20.9% versus 24.6% in Q4 FY25. On the earnings call, the CFO attributed this decline to a one-time expected credit loss provision of INR 10 crore, and stated that excluding this one-time item, the margin would have been around 25%.

This matters because it helps separate operating momentum from accounting conservatism. The company described its ECL provisioning approach as structured and auditor-reviewed, but did not provide account-level detail.

Scale strategy: India consolidation plus international replication

NephroPlus positions itself as an end-to-end dialysis platform. Its delivery footprint spans captive clinics inside private hospitals on revenue-sharing arrangements, government PPP clinics, and standalone centres. As of March 31, 2026, the investor deck showed 272 captive clinics, 182 PPP clinics, and 70 standalone clinics.

The company’s stated growth pillars include consolidating its leadership position in India and scaling international operations in the Philippines, Uzbekistan, and Saudi Arabia. In the Philippines, management emphasised continued roll-up of smaller centres and described the market as having a long tail of unorganised providers. In Uzbekistan, expansion is described as building on trust with the Ministry of Health and as ROCE accretive. Saudi Arabia remains in an investment phase through a 51:49 joint venture with Tibbiyah, with management highlighting tender-driven growth and timing uncertainty.

A key operational theme is that the company is trying to replicate an India-honed cost and process playbook into higher price-point markets. In the investor presentation, it highlighted procurement scale, in-house training, biomedical maintenance, and overhead discipline as the levers that support cost leadership.

Technology and clinical protocols: building a distributed network advantage

The presentation placed strong emphasis on protocol-driven care and operational systems. It highlighted RenAssure as a standardised, evidence-based clinical protocol framework, and Renova as a cloud-enabled dialyzer reprocessing system. Management also discussed Reformmed.AI, describing it as a comprehensive dialysis operations platform already implemented in 50 plus clinics and intended to be scaled across the network.

The company also linked its clinical positioning to accreditations and internal systems. The deck cited 149 clinics accredited by NABH, 3 clinics accredited by JCI, and ISO 9001:2015 certification. It also referenced internal quality and operational audits, an advisory team of experts, and clinical research activity.

What to track from here

Management reiterated a medium-term revenue CAGR guidance of 15% to 20% over three to four years and explicitly stated it will not give annual guidance. For clinic expansion, management discussed a gross addition plan of 40 to 50 clinics in India and 12 to 15 in the Philippines, excluding any large PPP projects or major acquisitions.

The near-term watch items are clear from the call. First, the extent to which international expansion continues to lift RPT without introducing volatility in working capital and collections. Second, the cadence of PPP renewals in India, including a renewal process in Uttarakhand and a phase renewal expected in Andhra Pradesh later in the year. Third, progress in Saudi Arabia, where management expects continued investment-phase losses until tender visibility improves.

FY26 reinforced NephroPlus’s core pitch: dialysis is a scale business, and the company is using its distribution, protocols, and an India-built efficiency engine to grow in both low-price and higher-price markets. The sustainability of margins and returns will depend on how smoothly the international ramp continues and how disciplined capital allocation remains as the network expands.