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Goodwill
 9 Months Ended
Sep. 30, 2024
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, 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, 20236,416,825 695,735 7,112,560 
Acquisitions102,082 37,524 139,606 
Divestitures(1,687)(1,506)(3,193)
Foreign currency and other adjustments— (21,343)(21,343)
Balance at September 30, 2024$6,517,220 $710,410 $7,227,630 
Balance at September 30, 2024:
Goodwill$6,517,220 $860,669 $7,377,889 
Accumulated impairment charges— (150,259)(150,259)
$6,517,220 $710,410 $7,227,630 
The Company did not recognize any goodwill impairment charges during the nine months ended September 30, 2024 and 2023.
The Company performed various annual impairment assessments during the nine months ended September 30, 2024, with no impairment indicated. None of the Company's various reporting units were considered at risk of significant goodwill impairment as of September 30, 2024.