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Segment reporting
 6 Months Ended
Jun. 30, 2021
Segment Reporting [Abstract]  
Segment Reporting Disclosure Segment reporting
The Company’s operations are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its various ancillary services including its international operations (collectively, its ancillary services), and its corporate administrative support.
The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the Asia Pacific joint venture (APAC JV). The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services operating segments, including the international operating segments, have been combined and disclosed in the other segments category. See Note 25 to the Company's consolidated financial statements included in the 2020 10-K for further description of how the Company determines and measures results for its operating segments.
The following is a summary of segment net revenues, segment operating income (loss), and a reconciliation of segment operating income (loss) to consolidated income before income taxes:
Three months ended June 30,Six months ended June 30,
 2021202020212020
Segment revenues:  
U.S. dialysis  
Dialysis patient service revenues:  
External sources$2,648,676 $2,631,827 $5,204,936 $5,211,067 
Intersegment revenues21,247 35,122 48,190 67,062 
U.S. dialysis patient service revenues2,669,923 2,666,949 5,253,126 5,278,129 
Other revenues(1):
External sources6,345 7,688 12,961 12,830 
Intersegment revenues70 307 130 608 
Total U.S. dialysis revenues2,676,338 2,674,944 5,266,217 5,291,567 
Other—Ancillary services  
Dialysis patient service revenues169,281 126,370 327,608 260,411 
Other external sources92,208 114,094 191,006 236,908 
Intersegment revenues— 4,171 4,294 8,324 
Total ancillary services revenues261,489 244,635 522,908 505,643 
Total net segment revenues2,937,827 2,919,579 5,789,125 5,797,210 
Elimination of intersegment revenues(21,317)(39,600)(52,614)(75,994)
Consolidated revenues$2,916,510 $2,879,979 $5,736,511 $5,721,216 
Segment operating income (loss):    
U.S. dialysis$533,779 $522,630 $1,013,686 $1,014,236 
Other—Ancillary services(17,808)(39,622)(29,668)(42,268)
Total segment operating income515,971 483,008 984,018 971,968 
Reconciliation of segment operating income to consolidated
 income from continuing operations before income taxes:		    
Corporate administrative support(25,495)(73,088)(50,940)(96,672)
Consolidated operating income490,476 409,920 933,078 875,296 
Debt expense(73,324)(81,381)(140,338)(169,984)
Debt refinancing charges— — — (2,948)
Other income, net15,188 9,545 16,356 5,195 
Consolidated income from continuing operations
 before income taxes		$432,340 $338,084 $809,096 $707,559 
(1)Includes management fee revenue from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling equity investment or which are wholly-owned by third parties.
Depreciation and amortization expense by reportable segment was as follows:
Three months ended June 30,Six months ended June 30,
 2021202020212020
U.S. dialysis$159,856 $148,312 $315,802 $294,612 
Other—Ancillary services9,833 9,064 19,588 17,443 
 $169,689 $157,376 $335,390 $312,055 
Expenditures for property and equipment by reportable segment were as follows:
Six months ended June 30,
 20212020
U.S. dialysis$271,884 $280,801 
Other—Ancillary services22,554 10,866 
 $294,438 $291,667 
 
A summary of assets by reportable segment was as follows:
June 30, 2021December 31, 2020
U.S. dialysis$16,084,542 $15,344,647 
Other—Ancillary services1,725,769 1,643,869 
Consolidated assets$17,810,311 $16,988,516