AKBA · Akebia Therapeutics
Conviction · Low · more likely to lag the S&P 500 over the next three months
Wrong if: a daily close above $0.69
Note written ·
Price against the kill line
31.3% clear of its kill line on the 13 November 2026 close.
How to read this
This note expects the shares to lag the market, so its kill line sits above the price: a close above the red mark would prove the view wrong. Prices run from low on the left to high on the right. The dot is where the stock closed on 13 November 2026, left of the mark while it is below the line; a dot right of the mark has closed through it.
The scale is stretched near the line, so close calls are easy to see. More than 8% from the line, the stock reads well clear, with a hollow dot to show the figure is off the drawn scale.
The kill line is the research note's own test. The portfolio sells on business facts, not on a price. How the portfolio decides
Three months against the kill line
Daily closes, to . Red: the kill line, a daily close above $0.6900, on record since 11 November 2026. The shares are down 44.9% since the close; the S&P 500 is down 2.1% over the same sessions. Figures in the note can cover a different window.
Kill line
A daily close above $0.69, the close before the 5 November 2026 results, which would show the shares leading. A fourth-quarter Vafseo revenue figure above the $21.3 million of the second quarter of 2026 would also show the call failing.
Research onlyNot in the portfolio.
Catalyst
Key figures from the filings · Health Care
Quarter to 30 September 2026, filed 5 November 2026; valuation at the 13 November 2026 close
- Revenue, latest quarter ($M)
- 36.9
- Revenue, change on a year (%)
- −37.2
- Gross margin (%)
- 82.8
- Operating margin (%)
- −31.1
- Free cash flow, four quarters ($M)
- 13.9
- Net cash, cash less debt ($M)
- 109
- Enterprise value to sales (×)
- 0.1
- Free-cash-flow yield (%)
- 10.5
All filed numbers
What Akebia Therapeutics reports to the SEC in its quarterly and annual filings. Each group states its period and filing date once; a figure dated otherwise says so. Built from the filings known on .
| Quarter to | Revenue ($M) | On a year (%) | Gross margin (%) | Operating margin (%) |
|---|---|---|---|---|
| first filed | 36.9 | −37.2 | 82.8 | −31.1 |
| first filed | 49.1 | −21.4 | 78.8 | −12.9 |
| first filed | 53.5 | −6.6 | 77.0 | −8.8 |
| first filed | 57.6 | +23.9 | 78.2 | −14.8 |
| first filed | 58.8 | +57.0 | 84.0 | 7.6 |
| first filed | 62.5 | +43.1 | 84.1 | 22.6 |
| Pre-tax income ($M) | −14.2 |
| Net income ($M) four quarters: −44.6 | −14.4 |
| Diluted shares, change on a year (%) against the quarter to 30 September 2025 | +0.9 |
| Operating cash flow ($M) | 15.8 |
| Capital spending ($M) | 1.9 |
| Free cash flow ($M) | 13.9 |
| Cash and short-term investments ($M) | 159 |
| Debt ($M) long-term debt | 50.3 |
| Net cash, cash less debt ($M) | 109 |
| Deferred revenue ($M) +27.8% on a year | 5.0 |
| Backlog, orders not yet delivered ($M) | Not reported |
| Receivables ($M) | 36.4 |
| Inventory ($M) | 18.7 |
| Shareholders' equity ($M) | 20.4 |
| Market value ($M) | 132 |
| Enterprise value, market value plus net debt ($M) | 22.7 |
| Enterprise value to sales (×) | 0.1 |
| Enterprise value to operating income (×) | Not meaningful |
| Price to earnings (×) | Not meaningful |
| Price to book value (×) | 6.5 |
| Free-cash-flow yield (%) | 10.5 |
Short interest (FINRA, settled 15 October 2026, published 26 October 2026): 8.3% of shares outstanding sold short, 3.0 days of average trading to cover, +2.6% since the previous report.
| Window | Bought | Sold |
|---|---|---|
| 90 daysfrom | $0 | $0 |
| 12 monthsfrom | $87K | $963K |
The thesis
Akebia Therapeutics' kidney drug Vafseo is adding patients, but the shares are more likely to lag the S&P 500 over the next three months. Third-quarter 2026 revenue missed estimates, and Vafseo's price resets when the transitional add-on payment ends on 31 December 2026. That date and the pending term loan refinancing settle the case.
Total revenue for the third quarter of 2026 was $36.9 million against $58.8 million a year earlier, and Benzinga lists a consensus estimate of $46.941 million (Akebia Form 8-K and Benzinga, 5 November 2026). The shares closed at $0.50 on 12 November 2026, 73.5% below the 52-week intraday high of $1.89 set on 12 November 2025, and the three-month change is −42.9%.
Positive VOCAL trial data and a record patient count on 5 November 2026 did not lift the shares. They hit a 52-week closing low of $0.40 on 6 November 2026, rebounded to $0.57 on 11 November 2026, and gave back part of that on 12 November 2026.
Bullish and bearish views on Akebia Therapeutics, Inc.
The bull case on Akebia Therapeutics, Inc. (AKBA), in brief: patient count keeps rising. The bear case: revenue missed by a wide margin.
Bull case
- Patient count keeps rising. About 11,500 patients were on Vafseo at the end of the third quarter of 2026, up roughly 8.1% from the second quarter and about 140% from the third quarter of 2025 (Akebia 8-K, 5 November 2026).
- A second trial met its goal. The open-label VOCAL trial found that vadadustat dosed three times weekly was non-inferior to the injected anemia drug Mircera in maintaining hemoglobin (company release, 5 November 2026).
- Cash is large against the share price. Akebia held $159.3 million in cash and equivalents on 30 September 2026, up from $155.5 million on 30 June 2026, and says cash, expected revenue and a planned refinancing fund operations for at least two years (8-K, 5 November 2026).
- Large dialysis chains are starting. Management said on the third-quarter call that DaVita plans a slow Vafseo rollout from the fourth quarter of 2026 and a larger push in early 2027 (Finviz summary of the call, 5 November 2026).
- Analyst targets sit far above the price. BTIG's target is $3 (5 November 2026) and HC Wainwright's is $4, cut from $6 with a Buy rating kept (6 November 2026).
Bear case
- Revenue missed by a wide margin. Third-quarter revenue fell 37.2% from a year earlier, and the loss was $0.05 per share against a $0.04 estimate (Benzinga, 5 November 2026).
- Vafseo fell from the previous quarter. Vafseo net revenue was $14.8 million against $21.3 million in the second quarter of 2026 and $14.3 million in the third quarter of 2025 (8-K, 5 November 2026). Management attributed about $4 million to $5 million of the shortfall to an inventory reduction at its largest customer and expects further destocking before the add-on payment ends (Finviz summary, 5 November 2026).
- Auryxia is still shrinking. Auryxia revenue was $20.0 million against $25.5 million in the second quarter of 2026 and $42.5 million in the third quarter of 2025 (8-K, 5 November 2026).
- Post-add-on pricing is low. Management guided to an annual cost of therapy of about $1,000 to $1,500 per patient after the add-on payment ends, inside the range of older anemia drugs (Finviz summary, 5 November 2026).
- Funding is mixed. Stockholders' equity was about $20.4 million, and the quarter included $6.6 million of at-the-market equity proceeds (Finviz summary, 5 November 2026). The two-year runway depends on refinancing the senior secured term loan, a BlackRock facility from January 2024 of up to $55.0 million, and no refinancing terms have been announced.
Price setup
The shares closed at $0.50 on 12 November 2026, against $0.53 on 9 November 2026, $0.54 on 10 November 2026 and $0.57 on 11 November 2026. The 52-week closing low is $0.40 on 6 November 2026, and the 3-month reference close was $0.87 on 14 August 2026.
The 50-day average of adjusted closes is $0.78 and the 200-day average is $1.11 as of 12 November 2026, so the shares trade well under both. A recovery would need to retake the 50-day average before the trend reads as turning.
Nasdaq issues a deficiency notice after 30 consecutive business days of closes below $1.00, with a 180-day cure period. Company news through 12 November 2026 shows no such notice. Akebia regained compliance once before, on 22 May 2023.
Catalysts ahead
- 31 December 2026: Vafseo transitional add-on payment ends. Pricing moves into the range of older anemia drugs in 2027, testing whether patient volume offsets the lower price.
- December 2026 (Q4, undated): DaVita begins a slow Vafseo rollout, per management. Early orders show whether volume growth can offset the lower post-add-on price.
- Undated: Senior secured term loan refinancing. The two-year runway statement depends on it; terms would show the financing cost and any dilution.
- Undated: Possible Nasdaq minimum-bid deficiency notice. Closes under $1.00 for 30 consecutive business days trigger a notice and a 180-day cure period.
- ~March 2027 (est.): Fourth-quarter 2026 results. First report to show Vafseo revenue after destocking and ahead of the price reset, and whether Auryxia falls below $20.0 million.
What would change the view
A daily close above $0.69, the close before the 5 November 2026 results, which would show the shares leading. A fourth-quarter Vafseo revenue figure above the $21.3 million of the second quarter of 2026 would also show the call failing.
What it trades with
Akebia trades on its own news: quarterly reports, financing events and Nasdaq compliance. Revenue depends on the large dialysis operators DaVita and Fresenius, which buy Vafseo, and on generic competition against Auryxia. Positive VOCAL data on 5 November 2026 coincided with a fall to the 52-week closing low the next session, so revenue and financing have outweighed clinical headlines for the shares.
The evidence, claim by claim (7)
- Third-quarter 2026 total revenue was $36.9 million versus $58.8 million a year earlier; Vafseo $14.8 million (second quarter of 2026: $21.3 million); Auryxia $20.0 million versus $42.5 million. Akebia Form 8-K, third-quarter 2026 release · as of
- Third-quarter 2026 sales of $36.9 million missed the $46.941 million estimate; loss per share of $0.05 versus a $0.04 estimate. Benzinga · as of
- About 11,500 patients on Vafseo, up roughly 8.1% from the second quarter of 2026 and about 140% from the third quarter of 2025. Akebia Form 8-K, third-quarter 2026 release · as of
- Cash and equivalents were $159.3 million at 30 September 2026; a runway of at least two years depends partly on refinancing the senior secured term loan. Akebia Form 8-K, third-quarter 2026 release · as of
- The VOCAL trial of three-times-weekly vadadustat met its primary non-inferiority endpoint against Mircera on hemoglobin change. Akebia release via Finviz · as of
- BTIG cut its price target to $3; HC Wainwright cut its target to $4 from $6 and kept a Buy rating. Benzinga · as of
- Closed at $0.50, 73.5% below the 52-week intraday high of $1.89 (12 November 2025); 52-week closing low $0.40 on 6 November 2026; 50-day average $0.78, 200-day average $1.11; three-month change −42.9%. Adjusted daily closes · as of
Sources