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Segment reporting (Tables)
3 Months Ended
Mar. 31, 2025
Segment Reporting [Abstract]  
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes
The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin (loss) to consolidated income before income taxes:
Three months ended March 31,
 20252024
Segment revenues:  
U.S. dialysis  
Patient service revenues:  
External sources$2,805,427 $2,725,575 
Intersegment revenues11,734 24,463 
U.S. dialysis patient service revenues2,817,161 2,750,038 
Other revenues
External sources6,008 6,122 
Total U.S. dialysis revenues2,823,169 2,756,160 
Other—Ancillary services
Patient service revenues297,566 215,957 
Other external sources114,528 122,901 
Intersegment revenues2,728 2,747 
Total ancillary services414,822 341,605 
Total net segment revenues3,237,991 3,097,765 
Elimination of intersegment revenues(14,462)(27,210)
Consolidated revenues$3,223,529 $3,070,555 
Significant segment expenses:
U.S. dialysis
Patient care costs$1,913,428 $1,824,579 
General and administrative282,679 274,562 
Depreciation and amortization156,899 172,852 
Other segment items(1)
(5,609)(41,570)
U.S. dialysis segment expenses2,347,397 2,230,423 
Other - Ancillary services expenses417,631 353,107 
Segment operating margin (loss):  
U.S. dialysis475,772 525,737 
Other—Ancillary services(2)
(2,809)(11,502)
Total segment operating margin (loss)472,963 514,235 
Reconciliation of segment operating income to consolidated income before income taxes:  
Corporate administrative support(34,026)(30,390)
Consolidated operating income438,937 483,845 
Debt expense(135,055)(99,418)
Other loss, net(17,549)(12,641)
Income from continuing operations before income taxes$286,333 $371,786 
Summary of Expenditures for Property and Equipment by Reportable Segment
Expenditures for property and equipment by reportable segment were as follows:
Three months ended March 31,
 20252024
U.S. dialysis$113,591 $104,953 
Other—Ancillary services29,667 16,062 
 $143,258 $121,015