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Goodwill (Tables) | 12 Months Ended
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Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract] |
Changes in Carrying Value of Goodwill by Reportable Segments | Changes in the carrying value of goodwill by reportable segments were as follows:
| U.S. dialysis and related lab services |  | Other ancillary services and strategic initiatives |  | Consolidated total
Balance at December 31, 2016 | $ | 5,691,587 |  |  | $ | 323,788 |  |  | $ | 6,015,375 |
Acquisitions | 485,434 |  |  | 131,598 |  |  | 617,032 |
Divestitures | (32,260 | ) |  | (126 | ) |  | (32,386 | )
Impairment charges | — |  |  | (36,196 | ) |  | (36,196 | )
Foreign currency and other adjustments | — |  |  | 46,454 |  |  | 46,454 |
Balance at December 31, 2017 | $ | 6,144,761 |  |  | $ | 465,518 |  |  | $ | 6,610,279 |
Acquisitions | 130,574 |  |  | 147,774 |  |  | 278,348 |
Divestitures | (331 | ) |  | (15,166 | ) |  | (15,497 | )
Impairment charges | — |  |  | (3,106 | ) |  | (3,106 | )
Foreign currency and other adjustments | — |  |  | (28,064 | ) |  | (28,064 | )
Balance at December 31, 2018 | $ | 6,275,004 |  |  | $ | 566,956 |  |  | $ | 6,841,960 |
Goodwill | $ | 6,275,004 |  |  | $ | 594,229 |  |  | $ | 6,869,233 |
Accumulated impairment charges | — |  |  | (27,273 | ) |  | (27,273 | )
| $ | 6,275,004 |  |  | $ | 566,956 |  |  | $ | 6,841,960 |
Schedule of Reporting Units Goodwill Balances | Based on the most recent assessments, the Company determined that reductions in reimbursement rates, changes in actual or expected growth rates, or other significant adverse changes in expected future cash flows or valuation assumptions could result in goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment as of December 31, 2018:
Reporting unit |  | Goodwill balance as of December 31, 2018 |  | Carrying amount coverage(1) |  | Sensitivities
Operating income(2) |  | Discount rate(3)
Germany Kidney Care |  | $ | 403,200 |  |  | 0.5 | % |  | (1.5 | )% |  | (10.3 | )%
Brazil Kidney Care |  | $ | 39,452 |  |  | 9.8 | % |  | (2.5 | )% |  | (7.3 | )%
Germany other health operations |  | $ | 12,646 |  |  | 8.1 | % |  | (2.2 | )% |  | (11.1 | )%
(1) | Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date.
(2) | Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
(3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.

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