v3.26.1
Segment reporting (Tables)
 6 Months Ended
Jun. 30, 2026
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, and a reconciliation of segment operating margin to consolidated income before income taxes:
Three months ended June 30,Six months ended June 30,
2026202520262025
Segment revenues:
U.S. dialysis
Patient service revenues:
External sources$2,993,948 $2,890,709 $5,908,902 $5,696,136 
Intersegment revenues11,361 16,716 31,833 28,450 
U.S. dialysis patient service revenues3,005,309 2,907,425 5,940,735 5,724,586 
Other revenues
External sources6,514 5,966 12,790 11,974 
Total U.S. dialysis revenues3,011,823 2,913,391 5,953,525 5,736,560 
Other—Ancillary services
Patient service revenues372,429 316,162 730,272 613,728 
Other external sources181,193 166,689 317,668 281,217 
Intersegment revenues3,087 2,836 6,375 5,565 
Total ancillary services556,709 485,687 1,054,315 900,510 
Total net segment revenues3,568,532 3,399,078 7,007,840 6,637,070 
Elimination of intersegment revenues(14,448)(19,552)(38,208)(34,015)
Consolidated revenues$3,554,084 $3,379,526 $6,969,632 $6,603,055 
Significant segment expenses:
U.S. dialysis
Patient care costs$2,004,694 $1,928,462 $3,973,750 $3,841,890 
General and administrative330,892 312,089 650,664 594,768 
Depreciation and amortization146,461 156,782 301,631 313,681 
Other segment items(1)
(8,200)(6,786)(16,464)(12,396)
U.S. dialysis segment expenses2,473,847 2,390,547 4,909,581 4,737,943 
Segment operating margin:
U.S. dialysis537,976 522,844 1,043,944 998,617 
Other—Ancillary services(2)
57,050 56,714 62,882 53,906 
Total segment operating margin595,026 579,558 1,106,826 1,052,523 
Reconciliation of segment operating income to consolidated
 income before income taxes:
Corporate administrative support(16,025)(41,717)(45,933)(75,745)
Consolidated operating income579,001 537,841 1,060,893 976,778 
Debt expense(150,256)(146,062)(295,387)(281,117)
Debt extinguishment and modification costs(2,035)— (2,035)— 
Other income (loss), net8,300 (22,851)12,773 (40,400)
Income before income taxes$435,010 $368,928 $776,244 $655,261 
Summary of Expenditures for Property and Equipment by Reportable Segment
Expenditures for property and equipment by reportable segment were as follows:
Six months ended June 30,
20262025
U.S. dialysis$229,523 $216,902 
Other—Ancillary services42,313 47,447 
$271,836 $264,349