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Goodwill
 6 Months Ended
Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill Goodwill
Changes in the carrying value of goodwill by reportable segment were as follows:
U.S. dialysisOther — Ancillary servicesConsolidated
Balance at December 31, 2021$6,400,162 $646,079 $7,046,241 
Acquisitions16,750 32,297 49,047 
Divestitures(87)(3,263)(3,350)
Foreign currency and other adjustments— (15,328)(15,328)
Balance at December 31, 2022$6,416,825 $659,785 $7,076,610 
Acquisitions— 690 690 
Foreign currency and other adjustments— 28,942 28,942 
Balance at June 30, 2023$6,416,825 $689,417 $7,106,242 
Balance at June 30, 2023:
Goodwill$6,416,825 $810,632 $7,227,457 
Accumulated impairment charges— (121,215)(121,215)
$6,416,825 $689,417 $7,106,242 
The Company did not recognize any goodwill impairment charges during the six months ended June 30, 2023 and 2022.
The Company's operations continue to be impacted by the effects of the coronavirus (COVID-19) pandemic. While the Company does not currently expect a material adverse impact to its business as a result of the ongoing COVID-19 pandemic, there can be no assurance that the magnitude of the cumulative impacts of the pandemic, including certain conditions and developments in the U.S. and global economies, labor market conditions, inflation and monetary policies that may have been intensified by the pandemic, will not have a material adverse impact on one or more of the Company's businesses.
Developments, events, changes in operating performance and other changes in key circumstances since the dates of the Company’s last annual goodwill impairment assessments have not caused management to believe it is more likely than not that the fair values of any of the Company's reporting units would be less than their respective carrying amounts as of June 30, 2023. Except for the Company's Germany kidney care reporting unit as described further in Note 10 to the Company's consolidated financial statements included in the 2022 10-K, none of the Company's various other reporting units were considered at risk of significant goodwill impairment as of June 30, 2023.