v3.25.4
Leases
 12 Months Ended
Dec. 31, 2025
Leases [Abstract]  
Leases Disclosure Leases
The Company leases substantially all of its dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. See Note 1 for further information on how the Company accounts for leases.
As of December 31, 2025 and December 31, 2024, assets recorded under finance leases were $291,850 and $309,363, respectively, and accumulated amortization associated with finance leases was $148,997 and $139,071, respectively, included in property and equipment, net, on the Company's consolidated balance sheet. Finance lease obligations are included in long-term debt. See Note 12 for further details on long-term debt.
In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long-term basis. Both the sale and leaseback terms are generally market terms. Substantially all of the lease terms are consistent with the Company's other leases with the majority of the leases under non-cancellable operating leases.
The components of lease expense were as follows:
Year ended December 31,
Lease cost202520242023
Operating lease cost(1):
Fixed lease expense$570,303 $557,591 $556,844 
Variable lease expense131,877 131,539 135,990 
Finance lease cost:
Amortization of leased assets26,596 28,262 26,964 
Interest on lease liabilities8,981 10,885 11,724 
Net lease cost$737,757 $728,277 $731,522 
(1)Includes short-term lease expense and sublease income, which are immaterial.
Other information related to leases was as follows:
Year ended December 31,
Lease term and discount rate202520242023
Weighted average remaining lease term (years):
Operating leases6.87.27.6
Finance leases7.47.98.5
Weighted average discount rate:
Operating leases4.3 %4.1 %4.0 %
Finance leases4.4 %4.6 %4.6 %
Year ended December 31,
Other information202520242023
Cash paid for amounts included in the
 measurement of lease liabilities:
Operating cash flows for operating leases$724,637 $719,339 $708,162 
Operating cash flows for finance leases$15,977 $18,599 $19,246 
Financing cash flows for finance leases$29,377 $29,592 $26,455 
Net operating lease assets obtained in exchange
 for new or modified operating lease liabilities		$379,803 $286,022 $269,564 
Future minimum lease payments as of December 31, 2025 are as follows: 
 Operating leasesFinance leases
2026$527,905 $34,621 
2027534,159 37,058 
2028468,263 33,639 
2029392,334 24,452 
2030310,800 18,643 
Thereafter767,612 65,472 
Total future minimum lease payments3,001,073 213,885 
Less portion representing interest(399,931)(28,765)
Present value of lease liabilities$2,601,142 $185,120 
Rent expense under all operating leases for the years ended December 31, 2025, 2024 and 2023 was $702,180, $689,130 and $692,834, respectively. Rent expense is recorded on a straight-line basis over the term of the lease, including leases that contain fixed escalation clauses or include abatement provisions. Leasehold improvement incentives reduce the carrying value of right-of-use assets and are amortized to rent expense over the term of the lease.