US healthcare budget cuts led to a fall in profit last year for Fresenius Medical Care, a leading supplier of dialysis machines and treatment.
FMC, which publishes its accounts in US dollars, said its net profit fell by 6.0 percent to $1.11 billion in 2013.
Underlying or operating profit rose by 2.0 percent to $2.256 billion on a 6.0-percent increase in revenues to $14.61 billion.
"With a very strong fourth quarter, we completed a sound fiscal year 2013 and achieved the targets we set for ourselves," said chief executive Rice Powell.
"Despite the impact of the reimbursement cuts in the US that were introduced last year we achieved another record in net revenue. Looking ahead we are faced with a challenging environment, in particular with structural changes due to growing pressure on reimbursement systems," he said.
The warning alarmed investors and FMC shares were the biggest losers on the Frankfurt stock exchange on Tuesday, shedding 8.45 percent in an overall market that was down just 0.40 percent.
FMC's parent company Fresenius, which is also listed on the stock exchange and publishes its accounts in euros, said it achieved record sales and earnings in 2013 and was confident for 2014.
"2013 was a year of significant achievements. We exceeded 20 billion euros ($27 billion) in sales and 1.0 billion euros in earnings for the first time," said Fresenius CEO Ulf Mark Schneider.
Net profit rose by 12 percent to 1.051 billion euros on a 5.0-percent increase in sales to 20.3 billion euros.
"Looking ahead, we see significant growth opportunities in both industrial and in developing countries," Schneider said.
For the current year, Fresenius said it is projecting sales growth of 12-15 percent at unchanged exchange rates and net profit was expected to increase by 2.0-5.0 percent.
"The earnings forecast primarily reflects lower reimbursement rates for Medicare dialysis patients and substantial uncertainties regarding the intravenous drug shortage situation in the US market," the company said.
Fresenius shares, which are also listed on Frankfurt's blue-chip DAX index, were down 6.7 percent.