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Goodwill | 3 Months Ended
--- | ---
Mar. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill | Goodwill Changes in the carrying value of goodwill by reportable segment were as follows:
| U.S. dialysis |  | Other — Ancillary services |  | Consolidated
Balance at December 31, 2022 | $ | 6,416,825 |  |  | $ | 659,785 |  |  | $ | 7,076,610 |
Acquisitions | — |  |  | 25,723 |  |  | 25,723 |
Impairment charges | — |  |  | (26,083) |  |  | (26,083) |
Foreign currency and other adjustments | — |  |  | 36,310 |  |  | 36,310 |
Balance at December 31, 2023 | $ | 6,416,825 |  |  | $ | 695,735 |  |  | $ | 7,112,560 |
Acquisitions | 102,082 |  |  | 35,208 |  |  | 137,290 |
Divestitures | (1,687) |  |  | — |  |  | (1,687) |
Foreign currency and other adjustments | — |  |  | (18,461) |  |  | (18,461) |
Balance at March 31, 2024 | $ | 6,517,220 |  |  | $ | 712,482 |  |  | $ | 7,229,702 |
Balance at March 31, 2024: |  |  |  |  |
Goodwill | $ | 6,517,220 |  |  | $ | 858,977 |  |  | $ | 7,376,197 |
Accumulated impairment charges | — |  |  | (146,495) |  |  | (146,495) |
| $ | 6,517,220 |  |  | $ | 712,482 |  |  | $ | 7,229,702 |
The Company did not recognize any goodwill impairment charges during the three months ended March 31, 2024 or the three months ended March 31, 2023. None of the Company's various reporting units were considered at risk of significant goodwill impairment as of March 31, 2024.

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