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Vitamin D blood level for reducing major medical risks in older adults ... - Science Daily (press release)

ScienceDaily (May 1, 2012) ? In testing older patients' blood vitamin D levels, there's uncertainty about where the dividing line falls between enough and not enough. The threshold amount has become controversial as several scientific societies set different targets.

To help resolve this debate, University of Washington researchers conducted an observational study. They wanted to learn how much vitamin D must be circulating in the blood to lower the risk of a major medical event. This category included heart attack, hip fracture, diagnosis of cancer, or death.

Their findings are reported May 1, in the Annals of Internal Medicine. Dr. Ian de Boer, assistant professor of medicine in the Division of Nephrology and a member of the Kidney Research Institute, led the project. He also holds an appointment in the Department of Epidemiology, UW School of Public Health.

Vitamin D is measured in the blood as 25-hydroxy-vitamin D, abbreviated 25(OH)D.

The researchers tested 25(OH)D concentrations from a biorepository of blood samples of 1,621 Caucasian adults. These adults had enrolled in the early 1990s in the Cardiovascular Health Study, originally designed to look at risk factors and progression of heart disease in people age 65 and over. The participants lived in one of four areas in the United States: Forsyth County, North Carolina; Sacramento, County, California; Washington County, Maryland; and Philadelphia, Pennsylvania.

Over about an 11-year follow-up, researchers looked at the association between each individual's 25(OH)D test results and the time that a first defining medical event occurred. Among the participants, 1,018 had such an event. There were 137 hip fractures, 186 heart attacks (myocardial infarctions), 335 incidents of cancer, and 360 deaths.

Through their statistical analysis, the researchers concluded that the risk of these disease events rose when the concentration of 25(OH)D fell below 20 ng/milliliter or 50 nmol/liter. "Our results," de Boer said, "lend support to the threshold level recently recommended by the Institute of Medicine, a national, independent government advisory group."He added, "This target level for adults is considerably lower than that set by other expert panels.'

His research team also found that the association of low 25(OH)D blood concentrations with risk of major disease events varied with the season. Because people soak up most of their Vitamin D from the sun, their levels run highest in the summer and lowest in the winter. Levels in autumn are generally above those in spring.

"In evaluating health risk," the researchers concluded, "Season-specific targets for 25(OH)D blood concentration may be more appropriate than a static target when evaluating patients health risk.

"Future research in this area, de Boer said, will require clinical trials. Researcher will look, for example, at the health effects of attempts to raise 25(OH)D in patients whose levels fall below the target. Interventions might include supplements, dietary changes and increasing outdoor activity.

"Sun exposure is tricky," de Boer said, "because people have to protect themselves from skin cancer and other sun damage." Sunscreen blocks the UVB waves responsible for producing Vitamin D. Food sources for Vitamin D are milk, fortified juice and cereal and oily fish like salmon, mackerel, cod and herring.

Vitamin D provides many different beneficial effects on health because it is actually not a vitamin, but a prohormone. It can suppress the hormonal systems that cause fluid to be retained and blood pressure to go up, modulate the function of immune cells, and stop abnormal cells from overgrowing.

In addition to de Boer, other UW authors of the research paper, "Serum 25-hydroxy vitamin D concentrations and risk of major clinical disease events in a community-based population" are Gregory Levin and Mary L. Biggs, Biostatistics; Cassianne Robinson-Cohen, Epidemiology; Andy Hoofnagle, Laboratory Medicine; David Siscovick, Cardiovascular Health Unit and Medicine and Epidemiology; and Bryan Kestenbaum, Nephrology, Kidney Research Institute and Epidemiology.

The research was funded by grants from the National Institutes of Health, including the National Heart, Lung and Blood Institute, the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, and the National Institute of Diabetes and Kidney Disease.

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Story Source:

The above story is reprinted from materials provided by University of Washington. The original article was written by Leila Gray.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Ian H. de Boer, Gregory Levin, Cassianne Robinson-Cohen, Mary L. Biggs, Andy N. Hoofnagle, David S. Siscovick, and Bryan Kestenbaum. Serum 25-Hydroxyvitamin D Concentration and Risk for Major Clinical Disease Events in a Community-Based Population of Older Adults. Ann Intern Med, May 1, 2012 156:627-634 [link]

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

...

 
DaVita 1st Quarter 2012 Results - MarketWatch (press release)

DENVER, May 01, 2012 (BUSINESS WIRE) -- DaVita Inc. /quotes/zigman/268700/quotes/nls/dva DVA +1.19% today announced results for the quarter ended March 31, 2012. Net income attributable to DaVita Inc. for the quarter ended March 31, 2012 was $140.1 million, or $1.46 per share. This compares to net income attributable to DaVita Inc. for the quarter ended March 31, 2011 of $94.5 million, or $0.96 per share.

Financial and operating highlights include:

-- Cash Flow: For the rolling twelve months ended March 31, 2012 operating cash flow was $1,182 million and free cash flow was $837 million. For the three months ended March 31, 2012 operating cash flow was $332 million and free cash flow was $250 million.

-- Operating Income: Operating income for the quarter ended March 31, 2012 was $321 million as compared to $235 million for the same period of 2011.

-- Volume: Total U.S. treatments for the first quarter of 2012 were 5,314,275, or 68,132 treatments per day, representing a per day increase of 14.2% over the first quarter of 2011. Non-acquired treatment growth in the quarter was 5.5% over the prior year's first quarter. Our normalized non-acquired treatment growth in the quarter was 5.3% over the prior year's first quarter.

-- Effective Tax Rate: Our effective tax rate was 36.7% for the quarter ended March 31, 2012. This effective tax rate is impacted by the amount of third party owners' income attributable to non-tax paying entities. The effective tax rate attributable to DaVita Inc. was 40.5% for the quarter ended March 31, 2012. We still expect our 2012 effective tax rate attributable to DaVita Inc. to be in the range of 40.0% to 41.0%.

-- Center Activity: As of March 31, 2012, we operated or provided administrative services at 1,841 outpatient dialysis centers located in the United States serving approximately 145,000 patients and 15 outpatient dialysis centers that are located in three countries outside of the United States. During the first quarter of 2012, we acquired 28 centers and opened a total of 13 centers located in the United States. We previously provided management and administrative services to nine of the acquired centers. In addition, we also opened a total of four centers outside of the United States.

Outlook

We are raising our operating income guidance for 2012 to now be in the range of $1,230 million to $1,310 million. Our previous operating income guidance for 2012 was in the range of $1,200 million to $1,300 million. We also still expect our operating cash flows for 2012 to be in the range of $950 million to $1,050 million. These projections and the underlying assumptions involve significant risks and uncertainties, including those described below, and actual results may vary significantly from these current projections.

We will be holding a conference call to discuss our results for the first quarter ended March 31, 2012 on May 2, 2012 at 9:30 a.m. Eastern Time. The dial in number is (800) 399-4406. A replay of the conference call will be available on DaVita's official web page, www.davita.com , for the following 30 days.

This release contains forward-looking statements, within the meaning of the federal securities laws, including statements related to our guidance and expectations for our 2012 operating income, our 2012 operating cash flows and our 2012 effective tax rate attributable to DaVita Inc. Factors that could impact future results include the uncertainties associated with governmental regulations, general economic and other market conditions, competition, accounting estimates, the variability of our cash flows and the risk factors set forth in our SEC filings, including our annual report on Form 10-K for the year ended December 31, 2011 and subsequent quarterly reports to be filed on Form 10-Q. The forward-looking statements should be considered in light of these risks and uncertainties.

These risks and uncertainties include those relating to:

-- the concentration of profits generated from commercial payor plans,

-- continued downward pressure on average realized payment rates from commercial payors, which may result in the loss of revenues or patients,

-- a reduction in the number of patients under higher-paying commercial plans,

-- a reduction in government payment rates under the Medicare End Stage Renal Disease program or other government-based programs,

-- the impact of health care legislation that was enacted in the United States in March 2010,

-- changes in pharmaceutical or anemia management practice patterns, payment policies, or pharmaceutical pricing,

-- our ability to maintain contracts with physician medical directors,

-- legal compliance risks, including our continued compliance with complex government regulations,

-- current or potential investigations by various government entities and related government or private-party proceedings,

-- continued increased competition from large and medium-sized dialysis providers that compete directly with us,

-- our ability to complete any acquisitions, mergers or dispositions that we might be considering or announce, or integrate and successfully operate any business we may acquire, and

-- expansion of our operations and services to markets outside the United States, or to businesses outside of dialysis.

We base our forward-looking statements on information currently available to us at the time of this release, and we undertake no obligation to update or revise any forward-looking statements, whether as a result of changes in underlying factors, new information, future events or otherwise.

This release contains non-GAAP financial measures. For reconciliations of these non-GAAP financial measures to their most comparable measure calculated and presented in accordance with GAAP, see the attached reconciliation schedules. For the reasons stated in the reconciliation schedules, we believe our presentation of non-GAAP financial measures provides useful supplemental information for investors.




                                                              DAVITA INC.
                                                   CONSOLIDATED STATEMENTS OF INCOME
                                                              (unaudited)
                                             (dollars in thousands, except per share data)
                                                                                          Three months ended March 31,
                                                                                  --------------------------------------------
                                                                                          2012                   2011
                                                                                       ----------             ----------
        Patient service operating revenues                                           $  1,763,700           $  1,497,434
        Less: Provision for uncollectible accounts related to patient                     (53,008)              (41,071)
        service operating revenues
                                                                                       ---------- ----        ---------- ----
            Net patient service operating revenues                                      1,710,692              1,456,363
        Other revenues                                                                    155,943                105,950
                                                                                       ----------             ----------
            Total net operating revenues                                                1,866,635              1,562,313
                                                                                       ----------             ----------
        Operating expenses and charges:
            Patient care costs                                                          1,263,159              1,114,086
            General and administrative                                                    207,389                151,602
            Depreciation and amortization                                                  75,975                 61,838
            Provision for uncollectible accounts                                            2,024                    972
            Equity investment income                                                       (2,632)               (1,519)
                                                                                       ---------- ----        ---------- ----
                 Total operating expenses and charges                                   1,545,915              1,326,979
                                                                                       ----------             ----------
        Operating income                                                                  320,720                235,334
        Debt expense                                                                      (61,381)              (58,595)
        Other income                                                                        1,039                    841
                                                                                       ----------             ----------
        Income from continuing operations before income taxes                             260,378                177,580
        Income tax expense                                                                 95,495                 62,959
                                                                                       ----------             ----------
        Income from continuing operations                                                 164,883                114,621
        Discontinued operations:
            Income from operations of discontinued operations, net of tax                        a"EUR               131
                                                                                  ---------------------       ----------
        Net income                                                                        164,883                114,752
            Less: Net income attributable to noncontrolling                               (24,763)              (20,250)
            interests
                                                                                       ---------- ----        ---------- ----
        Net income attributable to DaVita Inc.                                       $    140,120           $     94,502
                                                                                  ==== ==========        ==== ==========
        Earnings per share:
            Basic income from continuing operations per share attributable to        $       1.49           $       0.98
            DaVita Inc.
                                                                                  ==== ========== ====   ==== ========== ====
            Basic net income per share attributable to DaVita Inc.                   $       1.49           $       0.98
                                                                                  ==== ==========        ==== ==========
            Diluted income from continuing operations per share attributable to      $       1.46           $       0.96
            DaVita Inc.
                                                                                  ==== ========== ====   ==== ========== ====
            Diluted net income per share attributable to DaVita Inc.                 $       1.46           $       0.96
                                                                                  ==== ==========        ==== ==========
        Weighted average shares for earnings per share:
            Basic                                                                      93,769,092             96,263,802
                                                                                       ==========             ==========
            Diluted                                                                    95,729,105             98,378,371
                                                                                       ==========             ==========
        Amounts attributable to DaVita Inc.:
            Income from continuing operations                                        $    140,120           $     94,371
            Discontinued operations                                                              a"EUR               131
                                                                                  ---------------------       ----------
            Net income                                                               $    140,120           $     94,502
                                                                                  ==== ==========        ==== ==========
        





                                                         DAVITA INC.
                                       CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
                                                         (unaudited)
                                        (dollars in thousands, except per share data)
                                                                                    Three months ended March 31,
                                                                               --------------------------------------
                                                                                      2012                2011
                                                                                    -------             -------
        Net income                                                                $ 164,883           $ 114,752
                                                                               ---- -------        ---- -------
        Other comprehensive income (loss), net of tax:
        Unrealized losses on interest rate swap and cap agreements:
            Unrealized losses on interest rate swap and cap agreements               (2,261)            (4,134)
            Less: Reclassifications of net swap and cap agreements realized           2,520               1,743
            losses into net income
        Unrealized gains on investments:
            Unrealized gains on investments                                           1,146                 268
            Less: Reclassification of net investment realized gains into net            (75)               (57)
            income
        Foreign currency translation adjustments                                       (619)                  a"EUR
                                                                                    ------- ----   ------------------
            Other comprehensive income (loss)                                           711              (2,180)
                                                                                    -------             ------- ----
        Total comprehensive income                                                  165,594             112,572
            Less: Comprehensive income attributable to the noncontrolling           (24,763)           (20,250)
            interest
                                                                                    ------- ----        ------- ----
        Comprehensive income attributable to DaVita Inc.                            140,831           $  92,322
                                                                                    =======        ==== =======
        





                                                         DAVITA INC.
                                            CONSOLIDATED STATEMENTS OF CASH FLOWS
                                                         (unaudited)
                                                   (dollars in thousands)
                                                                                       Three months ended
                                                                                            March 31,
                                                                            ---------------------------------
                                                                                   2012                  2011
                                                                                ----------           -----------
        Cash flows from operating activities:
        Net income                                                            $    164,883         $     114,752
        Adjustments to reconcile net income to cash provided by operating
        activities:
            Depreciation and amortization                                           75,975                62,037
            Stock-based compensation expense                                        12,550                 9,716
            Tax benefits from stock award exercises                                 10,890                13,868
            Excess tax benefits from stock award exercises                          (6,101)              (7,196)
            Deferred income taxes                                                  (13,335)              18,221
            Equity investment income, net                                              483                 1,420
            Loss on disposal of assets and other non-cash charges                    7,125                 5,506
        Changes in operating assets and liabilities, other than from
        acquisitions and divestitures:
            Accounts receivable                                                    (71,706)             (20,461)
            Inventories                                                              4,851                 7,429
            Other receivables and other current assets                              56,452                24,922
            Other long-term assets                                                   3,742                   990
            Accounts payable                                                       (20,624)              26,565
            Accrued compensation and benefits                                       41,623                31,542
            Other current liabilities                                               17,462                 9,483
            Income taxes                                                            43,072                29,878
            Other long-term liabilities                                              4,532                 1,111
                                                                                ----------           -----------
                 Net cash provided by operating activities                         331,874               329,783
                                                                                ----------           -----------
        Cash flows from investing activities:
            Additions of property and equipment, net                              (112,459)             (67,530)
            Acquisitions                                                          (132,699)             (81,523)
            Proceeds from asset sales                                                  825                 2,812
            Purchase of investments available for sale                                (489)                (298)
            Purchase of investments held-to-maturity                                (3,212)             (15,161)
            Proceeds from sale of investments available for sale                     6,791                 1,149
            Proceeds from maturities of investments held-to-maturity                 7,551                15,163
            Distributions received on equity investments                                 2                    --
                                                                                ----------           -----------
                 Net cash used in investing activities                            (233,690)            (145,388)
                                                                                ---------- ---       ----------- ---
        Cash flows from financing activities:
            Borrowings                                                           8,634,603            10,983,125
            Payments on long-term debt                                          (8,658,001)         (11,000,635)
            Interest rate cap premiums and other deferred financing costs                3               (13,399)
            Distributions to noncontrolling interests                              (26,405)             (22,187)
            Stock award exercises and other share issuances, net                     1,663                 3,410
            Excess tax benefits from stock award exercises                           6,101                 7,196
            Contributions from noncontrolling interests                              3,651                 3,959
            Proceeds from sales of additional noncontrolling interests                 100                   785
            Purchases from noncontrolling interests                                 (4,372)                (756)
                                                                                ---------- ---       ----------- ---
                 Net cash used in financing activities                             (42,657)             (38,502)
        Effect of exchange rate changes on cash and cash equivalents                    11                    --
                                                                                ----------           -----------
        Net increase in cash and cash equivalents                                   55,538               145,893
        Cash and cash equivalents at beginning of period                           393,752               860,117
                                                                                ----------           -----------
        Cash and cash equivalents at end of period                            $    449,290         $   1,006,010
                                                                            === ==========       === ===========
        





                                                               DAVITA INC.
                                                       CONSOLIDATED BALANCE SHEETS
                                                               (unaudited)
                                              (dollars in thousands, except per share data)
                                                                                           March 31,            December 31,
                                                                                             2012                   2011
                                                                                     ------------------     ------------------
                                          ASSETS
        Cash and cash equivalents                                                       $    449,290           $    393,752
        Short-term investments                                                                 8,616                 17,399
        Accounts receivable, less allowance of $289,238 and $250,343                       1,266,869              1,195,163
        Inventories                                                                           72,285                 75,731
        Other receivables                                                                    216,493                269,832
        Other current assets                                                                  47,492                 49,349
        Deferred income taxes                                                                313,355                280,382
                                                                                          ----------             ----------
                 Total current assets                                                      2,374,400              2,281,608
        Property and equipment, net                                                        1,490,572              1,432,651
        Amortizable intangibles, net                                                         160,617                159,491
        Equity investments                                                                    26,956                 27,325
        Long-term investments                                                                  9,897                  9,890
        Other long-term assets                                                                30,065                 34,231
        Goodwill                                                                           5,064,577              4,946,976
                                                                                          ----------             ----------
                                                                                        $  9,157,084           $  8,892,172
                                                                                     ==== ==========        ==== ==========
                                  LIABILITIES AND EQUITY
        Accounts payable                                                                $    269,029           $    289,653
        Other liabilities                                                                    347,096                325,734
        Accrued compensation and benefits                                                    455,825                412,972
        Current portion of long-term debt                                                     89,646                 87,345
        Income tax payable                                                                    80,519                 37,412
                                                                                          ----------             ----------
                 Total current liabilities                                                 1,242,115              1,153,116
        Long-term debt                                                                     4,401,865              4,417,624
        Other long-term liabilities                                                          139,656                132,006
        Alliance and product supply agreement, net                                            18,655                 19,987
        Deferred income taxes                                                                448,372                423,098
                                                                                          ----------             ----------
                 Total liabilities                                                         6,250,663              6,145,831
        Commitments and contingencies
        Noncontrolling interests subject to put provisions                                   504,491                478,216
        Equity:
            Preferred stock ($0.001 par value, 5,000,000 shares authorized; none
            issued)
            Common stock ($0.001 par value, 450,000,000 shares authorized;                       135                    135
            134,862,283 shares issued; 93,983,930 and 93,641,363 shares
            outstanding)
            Additional paid-in capital                                                       575,364                596,300
            Retained earnings                                                              3,335,938              3,195,818
            Treasury stock, at cost (40,878,353 and 41,220,920 shares)                    (1,618,134)           (1,631,694)
            Accumulated other comprehensive loss                                             (18,773)              (19,484)
                                                                                          ---------- ----        ---------- ----
                 Total DaVita Inc. shareholders' equity         2,274,530              2,141,075
            Noncontrolling interests not subject to put provisions                           127,400                127,050
                                                                                          ----------             ----------
            Total equity                                                                   2,401,930              2,268,125
                                                                                          ----------             ----------
                                                                                        $  9,157,084           $  8,892,172
                                                                                     ==== ==========        ==== ==========
        





                                                                 DAVITA INC.
                                                         SUPPLEMENTAL FINANCIAL DATA
                                                                 (unaudited)
                                        (dollars in millions, except for per share and per treatment
                                                                    data)
                                                                                                    Three months ended
                                                                                     ------------------------------------------------
                                                                                        March 31,      December 31,       March 31,
                                                                                          2012             2011             2011
                                                                                     -----------     -------------     -----------
        1. Consolidated Financial Results:
          Consolidated operating revenues                                              $ 1,920          $ 1,862          $ 1,603
          Consolidated net operating revenues                                          $ 1,867          $ 1,810          $ 1,562
          Operating income                                                             $ 320.7          $ 330.1          $ 235.3
          Operating income margin                                                         16.7 %           17.7 %        $  14.7 %
          Income from continuing operations attributable to DaVita Inc.                $ 140.1          $ 149.4          $  94.4
          Net income attributable to DaVita Inc.                                       $ 140.1          $ 148.1          $  94.5
          Diluted income from continuing operations per share attributable to          $  1.46          $  1.58          $  0.96
          DaVita Inc.
          Diluted net income per share attributable to DaVita Inc.                     $  1.46          $  1.56          $  0.96
        2. Consolidated Business Metrics:
          Expenses
             Patient care costs as a percent of consolidated operating revenues(1)        65.8 %           65.2 %           69.5 %
             General and administrative expenses as a percent of consolidated             10.8 %           10.4 %            9.5 %
             operating revenues(1)
             Total provision for uncollectible accounts as a percent of                    2.9 %            2.9 %            2.6 %
             consolidated operating revenues
             Consolidated effective tax rate attributable to DaVita Inc.(2)               40.5 %           38.0 %           40.0 %
        3. Segment Financial Results: (dollar amounts rounded to
        nearest million)
          Operating revenues
             Dialysis and related lab services patient service operating revenues      $ 1,767          $ 1,717          $ 1,500
               Less: Provision for uncollectible accounts related to patient               (53)            (52)            (41)
               service operating revenues
                                                                                         ----- ---        ----- ----       ----- ---
               Dialysis and related lab services net patient service operating         $ 1,714          $ 1,665          $ 1,459
               revenues
               Other revenues                                                                3                3                2
                                                                                         -----            -----            -----
               Total net dialysis and related lab services operating revenues            1,717            1,668            1,461
               Other - Ancillary services and strategic initiatives                        155              147              106
               Other - Ancillary services and strategic initiatives net patient              1                1                a"EUR
               service operating revenues
                                                                                         -----            -----        -----------
               Total net segment operating revenues                                      1,873            1,816            1,567
               Elimination of intersegment revenues                                         (6)             (6)             (5)
                                                                                         ----- ---        ----- ----       ----- ---
                  Total net consolidated operating revenues                            $ 1,867          $ 1,810          $ 1,562
                                                                                     === =====       ==== =====        === =====
           Operating Income
             Dialysis and related lab services operating income                        $   348          $   353          $   252
             Other - Ancillary services and strategic initiatives, including               (17)            (13)             (9)
             international dialysis operations operating losses
                                                                                         ----- ---        ----- ----       ----- ---
                  Total segment operating income                                       $   331          $   340          $   244
             Reconciling items:
               Stock-based compensation                                                    (13)            (12)            (10)
               Equity investment income                                                      3                2                2
                                                                                         -----            -----            -----
                  Consolidated operating income                                        $   321          $   330          $   235
                                                                                     === =====       ==== =====        === =====
        





                                                                   DAVITA INC.
                                                     SUPPLEMENTAL FINANCIAL DATA--continued
                                                                   (unaudited)
                                          (dollars in millions, except for per share and per treatment
                                                                      data)
                                                                                                  Three months ended
                                                                             ------------------------------------------------------------
                                                                                  March 31,          December 31,           March 31,
                                                                                    2012                 2011                 2011
                                                                             ---------------     -----------------     ---------------
        4. Segment Business Metrics:
          Dialysis and related lab services
            Volume
             Treatments                                                          5,314,275            5,227,167            4,594,550
             Number of treatment days                                                 78.0                 79.0                 77.0
             Treatments per day                                                     68,132               66,167               59,669
             Per day year over year increase                                          14.2 %               12.4 %                7.2 %
             Non-acquired growth year over year                                        5.5 %                4.4 %                4.0 %
            Operating revenues before provision for uncollectible accounts
             Dialysis and related lab services revenue per treatment           $    332.43          $    328.54          $    326.40
             Per treatment increase (decrease) from previous quarter                   1.2 %               (1.6 %)              (1.4 %)
             Per treatment increase (decrease) from previous year                      1.8 %               (0.8 %)              (5.0 %)
             Percent of consolidated revenues                                         92.0 %               92.2 %               93.6 %
            Expenses
             Patient care costs
               Percent of total segment operating revenues                            63.7 %               63.4 %               68.3 %
               Per treatment                                                   $    212.12          $    208.66          $    223.28
               Per treatment increase (decrease) from previous quarter                 1.7 %               (3.2 %)              (0.7 %)
               Per treatment decrease from previous year                              (5.0 %)              (7.2 %)              (5.8 %)
             General and administrative expenses
               Percent of total segment operating revenues                             9.5 %                8.9 %                8.2 %
               Per treatment                                                   $     31.51          $     29.45          $     26.72
               Per treatment increase (decrease) from previous quarter                 7.0 %                0.6 %               (3.5 %)
               Per treatment increase from previous year                              17.9 %                6.3 %                2.4 %
        5. Cash Flow:
             Operating cash flow                                               $     331.9          $     150.7          $     329.8
             Operating cash flow, last twelve months                           $   1,182.1          $   1,180.0          $     907.6
             Free cash flow(2)                                                 $     249.9          $      32.1          $     267.7
             Free cash flow, last twelve months(2)                             $     837.2          $     855.0          $     645.3
             Capital expenditures:
                Routine maintenance/IT/other                                   $      55.6          $      85.3          $      39.9
                Development and relocations                                    $      56.8          $      63.1          $      27.6
                Acquisition expenditures                                       $     132.7          $     150.3          $      81.5
        6. Accounts Receivable:
             Net receivables                                                   $     1,267          $     1,195          $     1,069
             DSO                                                                        63                   61                   62
        





                                                                  DAVITA INC.
                                                    SUPPLEMENTAL FINANCIAL DATA--continued
                                                                  (unaudited)
                                         (dollars in millions, except for per share and per treatment
                                                                     data)
                                                                                                     Three months ended
                                                                                     --------------------------------------------------
                                                                                      March 31,         December 31,         March 31,
                                                                                        2012                2011               2011
                                                                                     ---------         ------------         ---------
        7. Debt and Capital Structure:
             Total debt(3)                                                              $ 4,499             $  4,513           $ 4,301
             Net debt, net of cash(3)                                                   $ 4,050             $  4,119           $ 3,295
             Leverage ratio (see Note 1 on page 10)                                       2.55x                2.72x             2.58x
             Overall weighted average effective interest rate during the quarter           5.27 %               5.27 %            5.20 %
             Overall weighted average effective interest rate at end of the                5.28 %               5.27 %            5.34 %
             quarter
             Weighted average effective interest rate on the Senior Secured                4.63 %               4.61 %            4.67 %
             Credit Facilities at end of the quarter
             Effectively fixed interest rates as a percentage of our total debt(4)          100 %                100 %             100 %
             Share repurchases                                                          $     -             $      -           $  13.6
        8. Clinical: (quarterly averages)
          Dialysis adequacy -% of patients with Kt/V > 1.2 at the end of the                 97 %                 97 %              97 %
          quarter
          Patients with arteriovenous fistulas placed                                        69 %                 69 %              68 %
        



_________________




        (1)   Consolidated percentages of revenues are comprised of the dialysis
              and related lab services business, other ancillary services and
              strategic initiatives, as well as stock-based compensation expenses.
        (2)   These are non-GAAP financial measures. For a reconciliation of these
              non-GAAP financial measures to their most comparable measure
              calculated and presented in accordance with GAAP, see attached
              reconciliation schedules.
        (3)   The quarters ended March 31, 2012, December 31, 2011 and March 31,
              2011, exclude $7.4 million, $7.8 million and $8.0 million,
              respectively, of debt discounts associated with our Term Loan B and
              our Term Loan A-2 that are not actually outstanding debt principal.
        (4)   The Term Loan A-2 and Term Loan B are subject to LIBOR floors of
              1.00% and 1.50%, respectively. Because LIBOR, for all periods
              presented above, was lower than either of these floors, the interest
              rates on the Term Loan A-2 and the Term Loan B are treated as
              "fixed" for purposes of the table above. We have included both of
              these Term Loans in the fixed rate totals in the table above until
              such time as the LIBOR-based component of our interest rate exceeds
              1.00% on the Term Loan A-2 and 1.50% on the Term Loan B. At such
              time, we will then be subject to LIBOR-based interest rate
              volatility on the LIBOR variable component of our interest rate on
              all of the Term Loan A-2, as well as for the Term Loan B, but
              limited to a maximum rate of 4.00% on $1.25 billion of outstanding
              principal debt on the Term Loan B. The remaining $478 million
              outstanding principal balance of the Term Loan B is subject to
              LIBOR-based interest rate volatility above a floor of 1.50%.
        



DAVITA INC. SUPPLEMENTAL FINANCIAL DATA--continued (unaudited) (dollars in thousands)

Note 1: Calculation of the Leverage Ratio

Under the Company's Senior Secured Credit Facilities (Credit Agreement), the leverage ratio is defined as all funded debt plus the face amount of all letters of credit issued, minus cash and cash equivalents, divided by "Consolidated EBITDA". The leverage ratio determines the interest rate margin payable by the Company for its Term Loan A and revolving line of credit under the Credit Agreement by establishing the margin over the base interest rate (LIBOR) that is applicable. The following leverage ratio was calculated using "Consolidated EBITDA" as defined in the Credit Agreement. The calculation below is based on the last twelve months of "Consolidated EBITDA", pro forma for routine acquisitions that occurred during the period. The Company's management believes the presentation of "Consolidated EBITDA" is useful to investors to enhance their understanding of the Company's leverage ratio under its Credit Agreement.




                                                                                                           Rolling twelve months ended March 31, 2012
                                                                                                          --------------------------------------------
            Net income attributable to DaVita Inc.                                                                            $               523,619
            Income taxes                                                                                                                      348,174
            Interest expense                                                                                                                  226,855
            Depreciation and amortization                                                                                                     281,253
            Noncontrolling interests and equity investment income, net                                                                         99,324
            Other items                                                                                                                       127,847
                                                                                                                                ---------------------
               "Consolidated EBITDA"                                     $             1,607,072
                                                                                                          ===================== =====================
                                                                                                                         March 31, 2012
                                                                                                          --------------------------------------------
            Total debt, excluding debt discount of $7.4 million                                                               $             4,498,938
            Letters of credit issued                                                                                                           52,297
                                                                                                                                ---------------------
                                                                                                                                            4,551,235
            Less: cash and cash equivalents                                                                                                  (449,290)
                                                                                                                                --------------------- -
            Consolidated net debt                                                                                             $             4,101,945
                                                                                                          ===================== =====================
            Last twelve months "Consolidated EBITDA"                     $             1,607,072
                                                                                                          ===================== =====================
            Leverage ratio                                                                                                                      2.55x
                                                                                                          ============================================
        



In accordance with the Credit Agreement, the Company's leverage ratio cannot exceed 4.25 to 1.0 as of March 31, 2012. At that date the Company's leverage ratio did not exceed 4.25 to 1.0.

DAVITA INC. RECONCILIATIONS FOR NON-GAAP MEASURES (unaudited) (dollars in thousands)

1. Effective Income Tax Rates

We believe that reporting the effective income tax rate attributable to DaVita Inc. enhances an investor's understanding of DaVita's effective income tax rate for the periods presented because it excludes noncontrolling owners' income that primarily relates to non-tax paying entities and accordingly is more comparable to prior periods presentations regarding DaVita's effective income tax rate and is more meaningful to an investor to fully understand the related income tax effects on DaVita Inc.'s operating results. This is not a measure under GAAP and should not be considered as an alternative to the effective income tax rate calculated in accordance with GAAP.

Effective income tax rate as compared to the effective income tax rate attributable to DaVita Inc. is as follows:




                                                                                  Three months ended
                                                                ------------------------------------------------------
                                                                    March 31,        December 31,         March 31,
                                                                      2012               2011               2011
                                                                -------------     ---------------     -------------
        Income from continuing operations before income taxes     $ 260,378          $ 269,149          $ 177,580
                                                                === =======       ==== =======        === =======
        Income tax expense                                        $  95,495          $  91,710          $  62,959
                                                                === =======       ==== =======        === =======
        Effective income tax rate                                      36.7 %             34.1 %             35.5 %
                                                                    ======= ===        ======= ====       ======= ===
        





                                                                                                                     Three months ended
                                                                                                   ------------------------------------------------------
                                                                                                       March 31,        December 31,         March 31,
                                                                                                         2012               2011               2011
                                                                                                   -------------     ---------------     -------------
        Income from continuing operations before income taxes                                        $ 260,378          $ 269,149          $ 177,580
        Less: Noncontrolling owners' income primarily attributable to       (24,883)          (28,128)          (20,297)
        non-tax paying entities
                                                                                                       ------- ---        ------- ----       ------- ---
        Income before income taxes attributable to DaVita Inc.                                       $ 235,495          $ 241,021          $ 157,283
                                                                                                   === =======       ==== =======        === =======
        Income tax expense                                                                              95,495             91,710          $  62,959
        Less income tax attributable to noncontrolling interests                                          (120)             (119)              (47)
                                                                                                       ------- ---        ------- ----       ------- ---
        Income tax attributable to DaVita Inc.                                                       $  95,375          $  91,591          $  62,912
                                                                                                   === =======       ==== =======        === =======
        Effective income tax rate attributable to DaVita Inc.                                             40.5 %             38.0 %             40.0 %
                                                                                                       ======= ===        ======= ====       ======= ===
        



DAVITA INC. RECONCILIATIONS FOR NON-GAAP MEASURES (unaudited) (dollars in thousands)

2. Free cash flow

Free cash flow represents net cash provided by operating activities less income distributions to noncontrolling interests and capital expenditures for routine maintenance and information technology. We believe free cash flow is a useful adjunct to cash flow from operating activities and other measurements under GAAP, since free cash flow is a meaningful measure of our ability to fund acquisition and development activities and meet our debt service requirements. In addition, free cash flow excluding income distributions to noncontrolling interests provides an investor with an understanding of free cash flows that are attributable to DaVita Inc. Free cash flow is not a measure of financial performance under GAAP and should not be considered as an alternative to cash flows from operating, investing or financing activities, as an indicator of cash flows or as a measure of liquidity.




                                                                                                  Three months ended
                                                                                ------------------------------------------------------
                                                                                    March 31,        December 31,         March 31,
                                                                                      2012               2011               2011
                                                                                -------------     ---------------     -------------
        Cash provided by operating activities                                     $ 331,874          $ 150,659          $ 329,783
        Less: Income distributions to noncontrolling interests                      (26,405)          (33,245)          (22,187)
                                                                                    ------- ---        ------- ----       ------- ---
        Cash provided by operating activities attributable to DaVita Inc.           305,469            117,414            307,596
        Less: Expenditures for routine maintenance and information technology       (55,609)          (85,304)          (39,928)
                                                                                    ------- ---        ------- ----       ------- ---
        Free cash flow                                                            $ 249,860          $  32,110          $ 267,668
                                                                                === =======       ==== =======        === =======
        





                                                                                                  Rolling 12-Month Period
                                                                                -----------------------------------------------------------
                                                                                     March 31,          December 31,          March 31,
                                                                                       2012                 2011                2011
                                                                                ---------------     -----------------     --------------
        Cash provided by operating activities                                     $ 1,182,137          $ 1,180,046          $  907,619
        Less: Income distributions to noncontrolling interests                       (104,871)           (100,653)           (87,120)
                                                                                    --------- ---        --------- ----       -------- ---
        Cash provided by operating activities attributable to DaVita Inc.           1,077,266            1,079,393             820,499
        Less: Expenditures for routine maintenance and information technology        (240,047)           (224,366)          (175,181)
                                                                                    --------- ---        --------- ----       -------- ---
        Free cash flow                                                            $   837,219          $   855,027          $  645,318
                                                                                === =========       ==== =========        === ========
        



SOURCE: DaVita Inc.




        
        DaVita Inc. 
        Jim Gustafson 
        Investor Relations 
        (310) 536-2585
        



Copyright Business Wire 2012

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Don't cut more funding for dialysis treatment - Bakersfield Californian
Tuesday, May 01 2012 09:09 PM

Don't cut more funding for dialysis treatment

The caregiving team at DaVita Bakersfield Dialysis Center was honored to welcome Rep. Kevin McCarthy's staff representative, Vince Fong, to our facility last month. Our caregivers and our patients welcomed the opportunity to speak with him about the importance of quality dialysis care and the need to prevent any additional cuts to the Medicare End Stage Renal Disease (ESRD) benefit that allows us to provide life-saving care to our patients.

As a facility administrator of the largest dialysis facility in the U.S. who oversees the care of more than 440 patients who rely on quality dialysis care due to kidney failure, I am very familiar with the medical and financial issues my patients face every day.

My priority is to provide the best quality care to my patients, but Bakersfield Dialysis Center must have the resources to do so. I hope Rep. McCarthy will remember these vulnerable patients and carefully consider all options available before enacting any further cuts to the Medicare ESRD benefit. Our patients here in Bakersfield deserve nothing less.

We want to thank Vince Fong for taking the time to visit our facility to better understand kidney dialysis and hear from these vulnerable patients who require our care to survive.

Marc Cameron

Bakersfield

...

 
Currie faces heat from Opposition on dialysis care - CBC.ca
Currie faces heat from Opposition on dialysis care - CBC.ca The Prince County dialysis facility is one of two new sites opening to accomodate a 75 per cent increase in the number of dialysis patients on the Island. (CBC)

Islanders need to be consulted before any more services are removed from hospitals, member of the Opposition said during Question Period Tuesday.

That comes after news that dialysis services would be centralized in Charlottetown and Summerside.

Opposition MLAs wanted to know how Islanders in western and eastern P.E.I. could afford to access dialysis treatment once it's centralized at the Prince County Hospital and Queen Elizabeth Hospital.

“They want a government that doesn’t throw them under a bus. Dialysis is not only necessary to survival, but it’s time consuming and appointment times are very important to people,” said Hal Perry, MLA for Tignish-Palmer Road.

But Health Minister Doug Currie insisted that dialysis services will improve.

“Today we’re committed to expand on services, I clearly stated that the demand on dialysis has expanded by 75 per cent in three years, Madame Speaker, with the anticipation that it’s going to continue to grow,” Currie said in the legislature.

That explanation wasn't good enough for Perry or for Colin Lavie, the MLA from Souris-Elmira.

“Will you do the right thing and commit to keeping the dialysis centre in Souris and Alberton open?” Lavie questioned.

The Liberals have lost touch with Islanders’ needs in rural regions, according to Perry.

“Minister, seriously, what’s next? The ER in Alberton or perhaps the Western Hospital closed?” Perry asked.

Moving forward

Currie kept insisting that health care has to evolve.

“Tough decisions need to be made. It was their government that shut the emergency room down in Tyne Valley. It was their government that shut down the emergency room in Souris, Madame Speaker,” Currie said.

Perry said the Liberals treat western P.E.I. residents as second-class citizens.

Outside the Legislature, Currie said there hasn't been a plan developed yet for the people of eastern and western P.E.I. who will have to travel to Charlottetown and Summerside for dialysis .

“I haven’t had any formal conversations about a plan, how we’ll do that, but most importantly our priority is to make sure we’re providing the service to meet the intense demand on chronic kidney disease,” Currie told CBC News.

The Opposition accused the government of having a plan to slowly remove healthcare services, such as dialysis, from rural P.E.I.

Currie said he’s trying to maintain a full range of services, but that Islanders have to look at the big picture.

...

 
Fish Oil Benefit for Dialysis Grafts Unclear - MedPage Today

image
By Todd Neale, Senior Staff Writer, MedPage Today

Published: May 01, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

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Action Points

For patients with a new synthetic arteriovenous graft for hemodialysis vascular access, taking fish oil every day led to a mix of negative and positive results, a randomized trial showed.

The percentage of patients who had a loss of native graft patency through 1 year -- the primary outcome -- was lower with fish oil than with placebo, although the difference was not significant (48% versus 62%, P=0.06), according to Charmaine Lok, MD, of Toronto General Hospital, and colleagues.

When looking at the rate of the loss of native patency, however, the difference favored fish oil recipients and was statistically significant (3.43 versus 5.95 per 1,000 access-days, P<0.001), the researchers reported in the May 2 issue of the Journal of the American Medical Association.

The findings, which were originally reported at the American Society of Nephrology meeting last year, also showed advantages for fish oil on some secondary endpoints, including cardiovascular events and blood pressure.

"Although the risk of the primary endpoint was not significantly lower among fish oil recipients, this should be considered in the context of the apparent consistent clinical benefits observed for the secondary outcomes," Lok and colleagues wrote.

Agreeing in an accompanying editorial was Bradley Dixon, MD, of the University of Iowa in Iowa City, who noted that interpreting the results is not as straightforward as looking at the failed primary outcome.

"The secondary outcomes measuring the rate of loss of graft patency are important and relevant, and deserve the attention of physicians caring for patients receiving a new graft," he wrote.

Lok and colleagues noted that grafts have become increasingly less popular since the study was started, with most patients now receiving arteriovenous fistulas. Currently, only about 21% of patients receive a synthetic graft.

The declining appeal of synthetic arteriovenous grafts is related to the risk of recurrent stenosis and thrombosis. The omega-3 fatty acids in fish oil have been proposed as a solution to those problems.

"Identification of safe and inexpensive agents that prolong arteriovenous graft patency and reduce the frequency of interventions to salvage graft complications might encourage increased use of grafts," the researchers wrote.

Their study, the Fish Oil Inhibition of Stenosis in Hemodialysis Grafts (FISH) trial, was a randomized, double-blind, placebo-controlled trial performed at 15 North American dialysis centers from November 2003 to December 2010. It included 201 adults with end-stage renal disease.

For 1 year, the patients were randomized to either four fish oil capsules per day or matching placebo. The fish oil capsules contained 400 mg eicosapentaenoic acid (EPA) and 200 mg docosahexaenoic acid (DHA).

The primary outcome was the percentage of patients who developed graft thrombosis or required radiological or surgical intervention during follow-up.

Although the between-group difference in that outcome was not statistically significant, fish oil significantly reduced the rate of thrombosis (1.71 versus 3.41 per 1,000 access-days, P<0.001) and of corrective interventions (2.89 versus 4.92 per 1,000 access-days, P<0.001).

In addition, daily fish oil was associated with the following:

  • Improved cardiovascular event-free survival: HR 0.43, 95% CI 0.19 to 0.96, P=0.04
  • An improvement in mean systolic blood pressure: -3.61 versus +4.49 mm Hg, P=0.01
  • An increase in the percentage of patients who had at least one reduction in the dose or frequency of antihypertensives: 64% versus 42%, P=0.004

Lok and colleagues noted that the potential cardiovascular benefits of fish oil should be confirmed in future studies because of the small number of patients and events, which limited statistical power. The study was also limited by failure to achieve the target enrollment numbers.

In his editorial, Dixon said that available data do not support an increase in the use of hemodialysis grafts combined with fish oil capsules and antiplatelet therapy.

"Despite the reduction in the rate of graft thrombosis and angioplasty procedures with fish oil, the rate of these events is still lower with arteriovenous fistulas, and fistulas remain the preferred means of hemodialysis access," he wrote. "However, if a patient cannot obtain a fistula and requires a graft, use of fish oil and an antiplatelet agent appears reasonable, pending the results of further studies."

The study was supported by peer-reviewed grant funding from the Physician's Services Incorporated Foundation and the Canadian Institutes of Health Research (CIHR). During the study, Lok and two of her co-authors were supported by CIHR New Investigator Awards. Lok was also supported by the CIHR Randomized Clinical Trials Mentoring Program. The other authors reported support from Alberta Heritage Foundation for Medical Research Population Scholar Awards, a Government of Canada Research Chair, and the National Institute of Diabetes and Digestive and Kidney Diseases.

Lok reported that she had no conflicts of interest. Her co-authors reported relationships with Amgen, Leo, Roche, Merck, Baxter, Novartis, UpToDate, Oliver Medical Management, the University of Alabama at Birmingham, and the Center for Biostatistics and AIDS Research at Harvard School of Public Health.

Dixon reported receiving consulting fees from Proteon Therapeutics, Pervasis Therapeutics, Novita Therapeutics, and Shire Pharmaceuticals; receiving grants or grants pending from Proteon Therapeutics, Novartis Pharmaceuticals, Cardiokine, and Reata Pharmaceuticals; and receiving payment for lectures from the Cincinnati Hemodialysis Vascular Access Symposium and VEITHsymposium.

Primary source:Journal of the American Medical Association
Source reference:
Lok C, et al "Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial" JAMA 2012; 307: 1809-1816; DOI: 10.1001/jama.2012.3473.

Additional source: Journal of the American Medical Association
Source reference:
Dixon B "Fish oil and hemodialysis graft patency: does time matter?" JAMA 2012; 307: 1859-1860; DOI: 10.1001/jama.2012.4101.

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