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Goodwill (Tables) | 12 Months Ended
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Dec. 31, 2019
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 |  | Other - Ancillary services |  | Consolidated
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 |
Acquisitions | 18,089 |  |  | 72,137 |  |  | 90,226 |
Impairment charges | — |  |  | (124,892 | ) |  | (124,892 | )
Foreign currency and other adjustments | (5,993 | ) |  | (13,666 | ) |  | (19,659 | )
Balance at December 31, 2019 | $ | 6,287,100 |  |  | $ | 500,535 |  |  | $ | 6,787,635 |
Goodwill | $ | 6,287,100 |  |  | $ | 653,870 |  |  | $ | 6,940,970 |
Accumulated impairment charges | — |  |  | (153,335 | ) |  | (153,335 | )
| $ | 6,287,100 |  |  | $ | 500,535 |  |  | $ | 6,787,635 |
Schedule of Reporting Units Goodwill Balances |
Reporting unit |  | Goodwill balance |  | Carrying amount coverage(1) |  | Sensitivities
Operating income(2) |  | Discount rate(3)
Germany kidney care |  | $ | 295,151 |  |  | — | % |  | (1.3 | )% |  | (11.0 | )%
Brazil kidney care |  | $ | 88,551 |  |  | 4.4 | % |  | (2.8 | )% |  | (7.0 | )%
(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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- Definition Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13816-109267 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 2 -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13854-109267 + Details
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