‘If they don’t get care, they’re going to die’: The woman who runs the world’s largest kidney dialysis company

New popular weight-loss drugs such as Wegovy and Ozempic have an additional benefit: they can extend the lifespan of people with chronic kidney disease, says Helen Giza.

For Giza, who runs the world’s largest dialysis and kidney services company, Fresenius Medical Care (FME), and for the patients it serves, the new breed of weight-loss shots promises to be transformative.

Giza, originally from Wales, beams in via video link from Chicago, where she is preparing to launch an advanced dialysis treatment in the US.

The £8 billion company grew out of a pharmaceutical company founded in 1912 by German pharmacist Dr. Eduard Fresenius and started selling dialysis machines in 1966.

FME’s core business focuses on addressing some of the growing number of issues arising as countries around the world grapple with an aging population. A typical patient treated by FME in the U.S. is 65 years old, male, obese and has 10 to 12 other serious health problems, Giza says.

This includes chronic kidney disease, a debilitating, progressive disease that occurs when organs stop working properly. It eventually leads to kidney failure – known as end-stage renal disease – after which people have only a few weeks to live unless they receive treatment. Other chronic conditions, such as diabetes, can also lead to kidney failure, and people have only a few weeks to live unless they receive treatment.

There are estimated 7.2 million people in Great Britain living with chronic kidney disease, 13.5% of adults and 30 million people, or 15% of adults, in the US. Globally, a tenth of adults are affected, with millions dying every year because they lack access to affordable treatments.

Dialysis or a kidney transplant can help people live with chronic kidney disease for many years. Dialysis filters waste and excess fluid from the blood and should be performed at least three times a week for about three hours at a time.

Research now shows that semaglutide, the active ingredient in the diabetes and weight loss drugs Ozempic and Wegovy from Novo Nordisk, ensures that people with obesity or overweight and cardiovascular disease can live longer and in better health. The drug tirzepatide from the American company Eli Lilly, sold under the names Mounjaro and Zepbound, has also shown positive results from a study in patients with heart problems.

The cardiovascular benefit of weight-loss drugs could help patients with chronic kidney disease on dialysis live longer until their kidneys shut down, Giza says.

“If these new drugs provide cardiovascular benefits, which the studies show they do, people will still end up in end-stage kidney disease,” she says. “It does not cure kidney disease, but it does provide more protection. These drugs will delay the onset of end-stage renal disease.”

It will be a decade before the impact of the new weight-loss drugs, known collectively as GLP-1s, can be fully assessed, she says. Currently, only about 5% of the company’s patients use GLP-1, and 75% of them quit within a year, partly because of the “tough” side effects and because they are tired of having to take many different medications. However, medicine is working on more effective treatments.

Meanwhile, Giza has high hopes for the launch of FME’s advanced dialysis treatment machine in the US. The high-volume hemodiafiltration (HDF) device has been on the market in Europe for a decade, but is only now being rolled out in the US following approval from the health regulator, the Food and Drug Administration (FDA). HDF comes closer to the way kidneys work naturally, and significantly reduces mortality rates.

A international study Led by the University Medical Center Utrecht, it was found that patients receiving HDF had an average survival improvement of 23% compared to people receiving conventional hemodialysis over a period of two and a half years.

Giza says this could add an additional year and a half to the average lifespan of people with end-stage kidney disease, bringing it between seven and a half and eight and a half years in the US. “That is a real opportunity to bring this therapy to the largest market in the world and improve life expectancy.”

FME has 311,000 patients worldwide, including 206,000 in the US. It has 53 clinics and 4,300 patients in Britain, where it “works hand in hand with the National Health Service,” Giza says. “The commitments the Labor government has made to the NHS – it is a challenging task, and rebuilding trust is an important task. But it is clear that whether you are Labor or Conservative, the cost of health care is a challenge to manage.”

FME was formed in 1996 from the merger of Fresenius’ dialysis division with the American company National Medical Care, and acquired a number of dialysis clinics in the US. The company is listed on the Frankfurt and New York stock exchanges and Fresenius has a 32% stake following the split of FME from the group last year. Giza says: “I wouldn’t say we are German or American. We are truly global.”

To ease pressure on hospitals and save money, the company offers home dialysis kits, which account for 16% of all dialysis it performs worldwide. In Great Britain, 150 patients are currently doing dialysis at home.

This method “was growing quite rapidly before Covid,” Giza says, but has “stagnated” as staff shortages meant the people needed to train home patients had to be redeployed to clinics to keep them open.

“Home dialysis is not for everyone,” she admits, but says it lends itself to younger, healthier, working-age patients. “It does mean that a patient can do dialysis on his own schedule. They can do it at night and go to work and manage their dialysis much better.”

She joined FME as Chief Financial Officer at the end of 2019, a few months before the Covid-19 outbreak, and was promoted to Chief Executive in 2022.

The company has faced staff shortages to keep its clinics open during the pandemic. “If our patients don’t get the care they need, and they don’t get dialysis every other day, they’re going to die,” Giza says. “It was all hands to the pump and navigating the crisis that followed.”

As the company reeled from a series of profit warnings in 2022, Giza embarked on a turnaround program that included cutting around 5,000 administrative and management jobs.

The company has been embroiled in a series of product recalls and lawsuits over the years. It has also been criticized by unions for its labor practices in the US and the Philippines. FME said it is committed to following labor relations laws and practices and respecting employees’ right to collective bargaining.

Last October, the The attorneys general of New York, Georgia and New Jersey have filed suit against the company’s vascular care division for subjecting patients with end-stage renal disease to unnecessary surgeries and defrauding the Medicaid program. FME disputes the allegations in the lawsuit and is vigorously defending the lawsuit.

In April, following concerns from the US regulator, FME issued a recall for a type of dialysis equipment because patients weighing less than 40kg may be at risk from chemicals leaking from silicone tubing. There are 88 children or young people who use these products; No health problems have been reported. The company is working on catheter extension sets with silicone tubing that do not leach chemicals.

Giza grew up in a small town in Wales and her first job was in the car industry, which had replaced coal mining in the area. “That was a tough industry in the 1990s… where the fifth decimal place for costs really mattered,” she recalls. Due to her production experience, she was headhunted by the American pharmaceutical company Abbott in Great Britain.

She went to work for a joint venture between Abbott and Japan’s largest drugmaker, Takeda, and spent 10 years as Takeda’s chief financial officer in the US. She became part of the deal team behind the £46 billion takeover of British company Shire, known for hyperactivity drug Adderall, and led the subsequent integration.

It was a “once in a lifetime experience,” she says. “We took over a company of the same size as us. That’s really where my transformation experience comes from.”

CV

Age 56
Family Married, one son.
Education British Chartered Accountant; MBA from Kellogg School of Management at Northwestern University in Illinois, USA.
Pay €4.9 million (£4.1 million) in 2023.
Last holiday Family trip to New York and Mexico.
The best advice she’s received “Work hard and the rest will take care of itself.”
Biggest regret “No regrets – the twists and turns of life, the choices we make and the way we deal with them ultimately make us who we are.”
Phrase she overuses “Can we please double click?”
How she relaxes “Running outside is my happy place; I also do power yoga.”