v3.25.4
Segment Reporting
 12 Months Ended
Dec. 31, 2025
Segment Reporting [Abstract]  
Segment Reporting 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. See Note 1 "Organization" for a summary description of the Company's businesses.
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 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.
The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to assess the financial performance of and allocate resources among the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to more than one of the Company’s various operating lines of business. The chief operating decision maker uses segment operating margin to assess segment profitability and resource allocation. 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 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,
202520242023
Segment revenues:
U.S. dialysis
Patient service revenues:
External sources$11,707,376 $11,294,614 $10,823,525 
Intersegment revenues60,958 71,747 88,222 
U.S. dialysis patient service revenues11,768,334 11,366,361 10,911,747 
Other revenues
External sources24,610 24,356 25,251 
Total U.S. dialysis revenues11,792,944 11,390,717 10,936,998 
Other - Ancillary services
Patient service revenues1,299,810 965,761 751,416 
Other external sources611,273 530,819 539,955 
Intersegment revenues11,203 13,910 7,852 
Total ancillary services1,922,286 1,510,490 1,299,223 
Total net segment revenues13,715,230 12,901,207 12,236,221 
Elimination of intersegment revenues(72,161)(85,657)(96,074)
Consolidated revenues$13,643,069 $12,815,550 $12,140,147 
Significant segment expenses:
U.S. dialysis
Patient care costs$7,854,234 $7,497,576 $7,394,640 
General and administrative1,253,298 1,173,990 1,102,072 
Depreciation and amortization633,396 661,181 695,674 
Other segment items(1)
(32,217)(63,037)(29,966)
U.S. dialysis segment expenses9,708,711 9,269,710 9,162,420 
Other - Ancillary services expenses(2)
1,829,907 1,427,833 1,307,970 
Segment operating margin:
U.S. dialysis2,084,233 2,121,007 1,774,578 
Other - Ancillary services(3)
92,379 82,657 (8,747)
Total segment margin2,176,612 2,203,664 1,765,831 
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
Corporate administrative support(132,997)(113,181)(163,047)
Consolidated operating income2,043,615 2,090,483 1,602,784 
Debt expense(579,926)(470,469)(398,551)
Debt extinguishment and modification costs(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 
 
(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)Includes depreciation and amortization of $81,952, $62,679 and $49,769 in 2025, 2024 and 2023, respectively.
(3)Segment operating margin (loss) for Other - Ancillary services includes equity investment (income) loss of $(783), $1,701 and $2,103 in 2025, 2024 and 2023, respectively.
Expenditures for property and equipment by reportable segment were as follows: 
 Year ended December 31,
 202520242023
U.S. dialysis$471,548 $469,799 $501,149 
Other - Ancillary services104,316 85,644 66,836 
 $575,864 $555,443 $567,985 
The Company's international operations include approximately $399,423 and $317,488 in 2025 and 2024, respectively, of net property and equipment.
Net Property and Equipment International Operations
The Company's international operations include approximately $399,423 and $317,488 in 2025 and 2024, respectively, of net property and equipment.