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Exhibit 4.6


AMENDMENT


FOR


LEASE AGREEMENT FOR MANUFACTURING FACILITIES




Fresenius Immobilien-Verwaltungs-GmbH & Co Objekt
Schweinfurt KG,




|             | 
|------------ | 
| Landlord  | 





|                                                                 | 
|---------------------------------------------------------------- | 
|Fresenius Medical Care Deutschland GmbH, Bad Homburg
    v.d.H., | 
| Tenant                                                        | 

Whereas, Schweinfurt, Hafenstrasse 9


Whereas, 10-year


Whereas,


Now, Therefore,


Section 1.          Term
and Termination.






| |    |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
| | -- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
| | 1. | The lease relationship shall be renewed for a term of
    10 years. Therefore, the Lease Agreement shall terminate
    December 31, 2016.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
|
| | 2. | The Tenant shall be entitled to exercise two (2) options of
    a period of ten (10) years each, provided that it exercises
    the respective rights simultaneously with regard to all three
    (3) contracts listed in Exhibit B. The options must be
    exercised in writing not later than on December 31, 2014
    with regard to the first option and not later than on
    December 31, 2024 with regard to the second option. If the
    Tenant does not exercise any of the aforementioned options, the
    Landlord shall be entitled to a lump sum compensation in an
    amount equal to the rent for twelve (12) months on the
    basis of the rent for the month directly preceding the end of
    the lease contract, plus VAT.
|
| | 3. | In the event of termination of this Lease Agreement before the
    agreed date for which termination the Tenant is responsible, the
    Tenant shall be liable for any and all damage caused thereby, in
    particular, but not limited to, loss of rent, incidental
    expenses and other charges relating to the period for which the
    lease has been entered into. The same shall apply vice versa
    should the Landlord be responsible for the termination.                                                                                                                                                                                                                                                                           

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Section 2.          Escalator
Clause.










Section 3.          Others.




Section 4.          Governing
Law.




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|                                                                             |  |                                                   
|---------------------------------------------------------------------------- |  | --------------------------------------------------
|Fresenius Immobilien-Verwaltungs-GmbH
    & Co Objekt Schweinfurt KGLandlord |  | Fresenius Medical Care
     Deutschland GmbHTenant
|                                                                            
|Dr. Karl
    Dieter Schwab                                                   |  | Dr.
    Emanuele Gatti                            
|                                                                            
|Dr. Jürgen
    Götz                                                          |  | ppa.
    Dr. Rainer Runte                         

3