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Segment Reporting (Tables)
 12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes
The following is a summary of segment revenues, segment operating margin, and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
 Year ended December 31,
 202420232022
Segment revenues:   
U.S. dialysis   
Patient service revenues:   
External sources$11,294,614 $10,823,525 $10,488,327 
Intersegment revenues71,747 88,222 87,045 
U.S. dialysis patient service revenues11,366,361 10,911,747 10,575,372 
Other revenues
External sources24,356 25,251 24,447 
Intersegment revenues— — (10)
Total U.S. dialysis revenues11,390,717 10,936,998 10,599,809 
Other - Ancillary services
Patient service revenues965,761 751,416 688,137 
Other external sources530,819 539,955 408,983 
Intersegment revenues13,910 7,852 4,206 
Total ancillary services1,510,490 1,299,223 1,101,326 
Total net segment revenues12,901,207 12,236,221 11,701,135 
Elimination of intersegment revenues(85,657)(96,074)(91,241)
Consolidated revenues$12,815,550 $12,140,147 $11,609,894 
Significant segment expenses:
U.S. dialysis
Patient care costs$7,497,576 $7,394,640 $7,334,415 
General and administrative1,173,990 1,102,072 1,037,552 
Depreciation and amortization661,181 695,674 690,949 
Other segment items(1)
(63,037)(29,966)(28,417)
U.S. dialysis segment expenses9,269,710 9,162,420 9,034,499 
Other - Ancillary services expenses1,427,833 1,307,970 1,197,905 
Segment operating margin:
U.S. dialysis$2,121,007 1,774,578 1,565,310 
Other - Ancillary services(2)
82,657 (8,747)(96,579)
Total segment margin2,203,664 1,765,831 1,468,731 
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support(113,181)(163,047)(129,669)
Consolidated operating income2,090,483 1,602,784 1,339,062 
Debt expense(470,469)(398,551)(357,019)
Debt prepayment, extinguishment and modification costs(19,813)(7,962)— 
Other loss, net(69,808)(19,177)(15,765)
Income from continuing operations before income taxes$1,530,393 $1,177,094 $966,278 
 
(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interest.
(2)Segment operating margin (loss) for Other - Ancillary services includes equity investment loss of $1,701, $2,103 and $1,898 in 2024, 2023 and 2022, respectively.
Summary of Depreciation and Amortization Expense by Segment
Depreciation and amortization expense by reportable segment was as follows:
 Year ended December 31,
 202420232022
U.S. dialysis$661,181 $695,674 $690,949 
Other - Ancillary services62,679 49,769 41,653 
 $723,860 $745,443 $732,602 
Summary of Expenditures for Property and Equipment by Segment
Expenditures for property and equipment by reportable segment were as follows: 
 Year ended December 31,
 202420232022
U.S. dialysis$469,799 $501,149 $533,600 
Other - Ancillary services85,644 66,836 69,829 
 $555,443 $567,985 $603,429