Robert Powell -- Chairman and Chief Executive Officer
Thank you, Dominik, and a warm welcome from my side as well. Before we get into the specifics on 2018's performance and we talk about '19 and '20 and guidance, it's been a while since we talked a little bit about our strategic value and the things that we bring to the marketplace strategically. So, if you'll bear with me, I'll try to do this quickly but I think it's been a while since we discussed it and I'd like to cover it.
We are going to continue to move away from selling single products and continue to move toward selling comprehensive, innovative solutions that help practitioners and patients and caregivers provide the best care possible. Given our experience and the depth and the breadth of our 4,000 dialysis clinics around the world, I remain completely convinced that we are positioned to deliver the highest quality patient care and patient outcomes anywhere in the world.
We're also creating an opportunity for us to be able to capture growth in the developing economies. It's something that we've talked about quite a bit. Rice, you're too heavily invested in the U.S., you need to do more. So, we are doing more. We're now in 150 countries, as you know, with products. Fifty countries, providing service. There's a certain amount of risk that goes with those developing markets but we think we can handle that risk and it's the right move in order to continue to grow the entire portfolio and not be so dependent on one particular region or country.
And I remain convinced that our care coordination assets and the opportunity it gives us to manage risk, predictively predict where patients are going to go -- I'm not sure that's the right phrase, "predictively predict," but I'll stick with it -- and it also gives us a way to drive value-based care, particularly in the U.S., which is something that is not going to go away. And, in fact, it's going to become a bigger part of the dialysis industry in the years to come.
Now, looking at our home strategy, a couple of things I thought are very U.S.-specific but would be of interest to you. So, if you look at the split of the total treatments in 2018, you see that 88% were in-center and 12% were home. And that book, if you will, grew 4%. Now, focusing on the home treatments for 2018, we see that PD is 78% of those treatments and it grew 8%. Home hemodialysis is 22% of that book and yet it grew 14%. Combine those two and you see a 9% growth in 2018. I think you understand why we're so excited about NxStage, our capabilities, and their capabilities combined.
We continue to target 15% of our total treatments being in the home setting by 2022 and I'm optimistic that we can see better than 15% as we move through the next couple of years. In order to make this happen, we do have to make some investments. So, what is it that we're going to invest into if we're going to expand our home treatments?
Patients and physicians and nurses need to be educated. We have home training clinics. We may need to refurbish some, we may need to build some new ones.
For every home treatment that we want to provide, we have to get the product there. So, the distribution infrastructure in the U.S., specifically, has got to be maintained, it's got to expand, we have to look at the most novel and creative ways to not drop product off at the corner and expect people to pick it up, but to take it into their homes and make it as safe and easy for them to use the product, store it in the right location, rotate the inventory. This is more than just a delivery, per se. And then, obviously, we need equipment, bags, solutions, tubings, etc., as we look at what we have to put in the home for these patients.
We also believe that if we can do a better job of increasing early awareness to chronic kidney disease, we have more lead time to train patients, make sure they understand their options of in-center or home, and take advantage of trying to put these patients in the venue that they desire and that they're capable of functioning and thriving in.
Moving to Slide 5, again, to talk a little bit about developing economies and I think China is a great example just for you to take a look. And you can see healthcare expenditure in percent of GDP and look at the size of the diabetic population. We believe being an early mover is going to be key in China, as well as some of the other developing markets. We're leveraging 15 years of experience in China in the product business. Very competitive, yes, but competition doesn't mean you're not learning things and learning how to get better. And we are investing in our manufacturing capacities there, both for the home business in PD as well as some of the HD things that we'll need as our clinic book of business grows. And we'll continue to look at the opportunities, particularly in Asia, because it's the one place where we see care coordination opportunities in Australia. And you'll see later in the presentation, that's working quite well.
Now, moving to Slide 6 or Slide 7, you can see, as we have normally laid this out for you, you see clinic growth at 5%, patients at 4%, and treatments at 4%. I'm very proud and I'd like to say thank you to our employees at Fresenius Kidney Care because we were able to maintain our Five Diamond Star status at 99.96% of our in-center and home hemodialysis programs. And for those of you that know me, I would just simply round that up to 100%. But I'm very proud of the work these people are doing. This is the U.S.-focused activity but I can assure you that if you look at our clinic activities in the other regions, they do very well. They just have not set up a program like this yet.
Looking at Slide 8 at our quality outcomes, I think the thing I'll point out today is, if you drop down and look at days in the hospital per patient year, we're seeing progress in North America, 10.7 down to 10.2, EMEA, as well as Asia-Pacific. And I'd say flat to slightly up in Latin America. So, continuing to try to get our patients out of the hospital or keep them out of the hospital as best we can.
Turning to Slide 9 for the full year update, Q4 was a solid performance for us. We did achieve, and I'd say beat, in some cases, our revised full-year guidance. That's a bitter pill because it's not the guidance that we wanted. But the fact that we had to revise it and yet we were able to achieve it and succeed it a little bit, we take some comfort in that.
As we'll talk about later in the presentation, our GEP II activities are ahead of schedule. You've seen that we are proposing a 10% dividend increase. I'll talk a little more about that later. And, obviously, the big news that came across my phone at 2:00 a.m. this morning, German time, was that we will be closing the NxStage book of business. We'll close this transaction sometime in the next couple of days. We found out last night that it's been approved so we have a little work to do. But we'll get that closed and we'll be communicating with you after that's taken place.
If we can turn to Slide 10, looking at the revised full-year guidance, quickly, I'll just ask you to look at the reddish boxes on the right side of the page, where you can see revenue on a comparable basis, growth in constant currency at 4%, a slight beat to the guidance we gave you. And the same for net income. You've had these figures for a while so I won't read them to you but we are pleased with that performance.
Looking at the fourth quarter, specifically, again we see strong results there. The revenue, obviously, in North America was impacted by Sound and IFRS 15 implementation. We had some other income impacts that we've listed for you throughout the year, with the divestiture, the ballot, and FCPA. But, all in all, we think it's a good story and we're pleased that we were able to deliver results slightly ahead of the revised guidance.
Coming to Slide 12, I think the key thing here is -- would you just take a moment and look at the trend lines? This was the first time that we had given you this slide back last quarter and I'm very pleased when you look at where we are. And I'm not going to go through each of these but the lines are going in the right direction. Everybody's making progress. Things look better. I would highlight for you the same market treatment growth for the group at 3.2% and North America at 3%.
Looking at Slide 13, on the organic growth, everybody contributed to this. There are the ins and outs in North America. I'm not going to go through those again. But I'm particularly pleased with what we saw in Asia-Pacific and Latin America, in terms of their organic growth. So, every region is contributing.
Now, if we look at Q4 services on Slide 14, I will direct my comments to the last two columns on the right. We've talked about North America and the special impacts there. EMEA, the growth was driven by same market treatment growth and acquisitions, along with some organic growth. Asia-Pacific did very well. And I would also point out, if you look at the care coordination in the quarter in Asia-Pacific, you can see where they are progressing as well.
Turning to products, which I think was a concern for a number of people on the last quarter's call, Q4 products did very well. We're very pleased with what you've seen here. You can see on the dialysis products side, growth at 6% constant currency, organic growth at 7%. And I won't read these to you but you can see every region did well. Particularly, North America and Asia-Pacific, we're doing quite strong. And on the right, you can see the various product lines that they're in. In the sake of time and getting to your questions, I'm not going to walk you through each of those. They're there for your review.
Turning to Slide 16, again, we will be proposing at the AGM on May 16th a 10% increase in our dividend, taking us from €1.06 to €1.17. I'm proud to say this is the 22nd consecutive dividend increase that we've proposed.
And the share buyback. We've made it clear to you we're looking to buy up to €1 billion of shares. We'll do that over the next two years. For those of you that had the opportunity to meet with Mike and I and Dominik back in September, I think I would just say to you, we were listening and we do continue to listen.
What will we focus on in 2019? Looking at Slide 17, we will continue to focus on resolving some of the identified operational issues that we talked about last quarter. We are going to invest around €100 million in 2019 for cost optimization. I won't go into the details there. I'm sure you'll have questions and we'll be delighted to answer those for you in the Q&A. But the key point here is this will be accretive to net income in 2020 and, obviously, you've seen that in our 2020 guidance that we've given you.
We are doing a good job in GEP II. We can talk about that a little later. Obviously, one of the largest things that we'll be dealing with is the closure of NxStage and integrating them into Fresenius Medical Care.
So, that's the conclusion of my prepared remarks. I hope you could understand me. It's February and, yes, I have a cold from being on an airplane incessantly over the first two months of the year. So, hopefully, you could understand me. And, with that, I'll turn it over to Mike.
Fresenius Medical Care AG & Co. (FMS) Q4 2018 Earnings Conference Call Transcript -- The Motley Fool
