v3.25.4
Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($)
$ in Thousands
 3 Months Ended 12 Months Ended
Dec. 31, 2025
Sep. 30, 2025
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Segment Reporting Information [Line Items]          
Other revenues     $ 635,883 $ 555,175 $ 565,206
Total revenues     13,643,069 12,815,550 12,140,147
Operating Income (Loss)     2,043,615 2,090,483 1,602,784
Corporate administrative support     (132,997) (113,181) (163,047)
Debt expense     (579,926) (470,469) (398,551)
Debt extinguishment and modification costs $ (9,028) $ (5,150) (14,178) (19,813) (7,962)
Other loss, net     (102,688) (69,808) (19,177)
Income from continuing operations before income taxes     1,346,823 1,530,393 1,177,094
Segment Reporting Information footnote:          
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.     33,000 26,189 27,864
Patient care costs     9,243,476 8,598,521 8,319,717
General and administrative     1,673,630 1,538,341 1,473,984
Operating expenses and charges     11,599,454 10,725,067 10,537,363
Depreciation and amortization     715,348 723,860 745,443
Property and equipment, net of accumulated depreciation $ 2,812,966   2,812,966 2,940,916  
U S Dialysis          
Segment Reporting Information [Line Items]          
Total revenues     11,731,986 11,318,970 10,848,776
Other - Ancillary services          
Segment Reporting Information [Line Items]          
Total revenues     1,911,083 1,496,580 1,291,371
Segment Reporting Information footnote:          
Depreciation and amortization     81,952 62,679 49,769
Operating Segments          
Segment Reporting Information [Line Items]          
Total revenues     13,715,230 12,901,207 12,236,221
Operating Income (Loss)     2,176,612 2,203,664 1,765,831
Operating Segments | U S Dialysis          
Segment Reporting Information [Line Items]          
Operating Income (Loss)     2,084,233 2,121,007 1,774,578
Segment Reporting Information footnote:          
Patient care costs     7,854,234 7,497,576 7,394,640
General and administrative     1,253,298 1,173,990 1,102,072
Segment Reporting, Other Segment Item, Amount     (32,217) (63,037) (29,966)
Operating expenses and charges     9,708,711 9,269,710 9,162,420
Depreciation and amortization     633,396 661,181 695,674
Operating Segments | Other - Ancillary services          
Segment Reporting Information [Line Items]          
Operating Income (Loss)     92,379 82,657 (8,747)
Segment Reporting Information footnote:          
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.     783 (1,701) (2,103)
Operating expenses and charges     1,829,907 1,427,833 1,307,970
Operating Segments | U S Dialysis And Related Lab Services with Intersegment          
Segment Reporting Information [Line Items]          
Dialysis patient service revenues     11,768,334 11,366,361 10,911,747
Total revenues     11,792,944 11,390,717 10,936,998
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | External Sources          
Segment Reporting Information [Line Items]          
Dialysis patient service revenues     11,707,376 11,294,614 10,823,525
Other revenues     24,610 24,356 25,251
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | Intersubsegment Eliminations          
Segment Reporting Information [Line Items]          
Dialysis patient service revenues     60,958 71,747 88,222
Operating Segments | Other Operating Segments with Intersegment          
Segment Reporting Information [Line Items]          
Dialysis patient service revenues     1,299,810 965,761 751,416
Other revenues     611,273 530,819 539,955
Total revenues     1,922,286 1,510,490 1,299,223
Operating Segments | Other Operating Segments with Intersegment | Intersubsegment Eliminations          
Segment Reporting Information [Line Items]          
Dialysis patient service revenues     11,203 13,910 7,852
Intersegment Elimination          
Segment Reporting Information [Line Items]          
Total revenues     (72,161) (85,657) (96,074)
Intersegment Elimination | U S Dialysis          
Segment Reporting Information [Line Items]          
Total revenues     (60,958) (71,747) (88,222)
Intersegment Elimination | Other - Ancillary services          
Segment Reporting Information [Line Items]          
Total revenues     $ (11,203) $ (13,910) $ (7,852)