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Goodwill
 12 Months Ended
Dec. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill Goodwill
Changes in the carrying amount of goodwill by reportable segment were as follows:
 U.S. dialysisOther - 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 
Acquisitions102,082 246,987 349,069 
Divestitures(1,687)(1,506)(3,193)
Foreign currency and other adjustments— (83,220)(83,220)
Balance at December 31, 2024$6,517,220 $857,996 $7,375,216 
Balance at December 31, 2024:
Goodwill$6,517,220 $999,817 $7,517,037 
Accumulated impairment charges— (141,821)(141,821)
$6,517,220 $857,996 $7,375,216 
Substantially all of the Company’s operating segments described in Note 24 to these consolidated financial statements represents an individual reporting unit for goodwill impairment assessment purposes.
Within the U.S. dialysis operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit.
The Company has applied a similar aggregation to the dialysis centers within each of its international reporting units. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units.
The Company performed various annual impairment assessments during the year ended December 31, 2024, with no impairment indicated. None of the Company’s reporting units were considered at risk of significant goodwill impairment as of December 31, 2024.
During the year ended December 31, 2023, the Company performed its annual impairment assessment of its transplant software reporting unit and recognized a goodwill impairment charge of $26,083 in that reporting unit, or $19,575 net of tax. This charge resulted from a reduction in estimated fair value for the business driven primarily from the business not achieving its revenue targets, with reduced revenue expectations for future years, as well as an increase in the risk-free rate. After this impairment charge, the transplant software reporting unit had a goodwill balance of $14,424 remaining.