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Segment reporting
 6 Months Ended
Jun. 30, 2025
Segment Reporting [Abstract]  
Segment Reporting Disclosure Segment reporting
The Company’s operating divisions are composed of its U.S. dialysis and related lab services business (its U.S. dialysis business), its U.S. integrated kidney care business, its U.S. other ancillary services and its international operations (collectively, its ancillary services), as well as its corporate administrative support functions.
The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The chief operating decision maker does not review total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included.
The Company’s separate operating segments include its U.S. dialysis and related lab services business, its U.S. integrated kidney care business, its U.S. other ancillary services, and its operations in each foreign sovereign jurisdiction. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other operating segments have been combined and disclosed in the other segments category. See Note 24 to the Company's consolidated financial statements included in the 2024 10-K for further description of how the Company determines and measures results for its operating segments.
The following is a summary of segment revenues, segment operating margin, and a reconciliation of segment operating margin to consolidated income before income taxes:
Three months ended June 30,Six months ended June 30,
 2025202420252024
Segment revenues:  
U.S. dialysis  
Patient service revenues:  
External sources$2,890,709 $2,822,187 $5,696,136 $5,547,761 
Intersegment revenues16,716 12,925 28,450 37,389 
U.S. dialysis patient service revenues2,907,425 2,835,112 5,724,586 5,585,150 
Other revenues
External sources5,966 5,898 11,974 12,021 
Total U.S. dialysis revenues2,913,391 2,841,010 5,736,560 5,597,171 
Other—Ancillary services
Patient service revenues316,162 238,915 613,728 454,873 
Other external sources166,689 119,722 281,217 242,622 
Intersegment revenues2,836 3,823 5,565 6,570 
Total ancillary services485,687 362,460 900,510 704,065 
Total net segment revenues3,399,078 3,203,470 6,637,070 6,301,236 
Elimination of intersegment revenues(19,552)(16,748)(34,015)(43,959)
Consolidated revenues$3,379,526 $3,186,722 $6,603,055 $6,257,277 
Significant segment expenses:
U.S. dialysis
Patient care costs$1,928,462 $1,854,541 $3,841,890 $3,679,120 
General and administrative312,089 281,795 594,768 556,357 
Depreciation and amortization156,782 160,410 313,681 333,262 
Other segment items(1)
(6,786)(5,922)(12,396)(47,491)
U.S. dialysis segment expenses2,390,547 2,290,824 4,737,943 4,521,248 
Other - Ancillary services expenses428,973 381,052 846,604 734,159 
Segment operating margin:  
U.S. dialysis522,844 550,186 998,617 1,075,923 
Other—Ancillary services(2)
56,714 (18,592)53,906 (30,094)
Total segment operating margin579,558 531,594 1,052,523 1,045,829 
Reconciliation of segment operating income to consolidated
 income before income taxes:		  
Corporate administrative support(41,717)(25,196)(75,745)(55,586)
Consolidated operating income537,841 506,398 976,778 990,243 
Debt expense(146,062)(97,747)(281,117)(197,165)
Debt prepayment, extinguishment and modification costs— (9,732)— (9,732)
Other loss, net(22,851)(27,479)(40,400)(40,120)
Income from continuing operations before income
 taxes		$368,928 $371,440 $655,261 $743,226 
 
(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interests.
(2)Includes depreciation and amortization of $17,923 and $15,251 for the three months ended June 30, 2025 and 2024, respectively, and $37,474 and $29,482 for the six months ended June 30, 2025 and 2024, respectively.
Expenditures for property and equipment by reportable segment were as follows:
Six months ended June 30,
 20252024
U.S. dialysis$216,902 $211,171 
Other—Ancillary services47,447 34,569 
 $264,349 $245,740