v3.26.3
Segment reporting
 9 Months Ended
Sep. 30, 2026
Segment Reporting [Abstract]  
Segment Reporting Segment reporting
The Company’s separate operating segments include 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 operations in each foreign jurisdiction (collectively, its ancillary services). The Company also maintains a corporate administrative support function.
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, its Chief Executive Officer, 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 does not review total assets by segment to make decisions regarding resources; therefore, the total assets by segment disclosure has not been included.
Currently, 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 2025 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 September 30,Nine months ended September 30,
2026202520262025
Segment revenues:
U.S. dialysis
Patient service revenues:
External sources$3,021,624 $2,961,833 $8,930,526 $8,657,969 
Intersegment revenues22,008 11,932 53,841 40,382 
U.S. dialysis patient service revenues3,043,632 2,973,765 8,984,367 8,698,351 
Other revenues
External sources6,846 6,275 19,636 18,248 
Total U.S. dialysis revenues3,050,478 2,980,040 9,004,003 8,716,599 
Other—Ancillary services
Patient service revenues386,642 336,257 1,116,914 949,985 
Other external sources163,014 115,862 480,682 397,080 
Intersegment revenues2,110 2,771 8,485 8,336 
Total ancillary services551,766 454,890 1,606,081 1,355,401 
Total net segment revenues3,602,244 3,434,930 10,610,084 10,072,000 
Elimination of intersegment revenues(24,118)(14,703)(62,326)(48,718)
Consolidated revenues$3,578,126 $3,420,227 $10,547,758 $10,023,282 
Significant segment expenses:
U.S. dialysis
Patient care costs$2,053,888 $1,981,180 $6,027,638 $5,823,070 
General and administrative316,178 322,355 966,843 917,124 
Depreciation and amortization144,360 156,242 445,991 469,923 
Other segment items(1)
(8,127)(9,850)(24,592)(22,247)
U.S. dialysis segment expenses2,506,299 2,449,927 7,415,880 7,187,870 
Segment operating margin:
U.S. dialysis544,179 530,113 1,588,123 1,528,729 
Other—Ancillary services(2)
(18,644)1,219 44,238 55,125 
Total segment operating margin525,535 531,332 1,632,361 1,583,854 
Reconciliation of segment operating income to consolidated
 income before income taxes:
Corporate administrative support(26,280)(25,565)(72,213)(101,309)
Consolidated operating income499,255 505,767 1,560,148 1,482,545 
Debt expense(150,016)(150,557)(445,403)(431,674)
Debt extinguishment and modification costs— (5,150)(2,035)(5,150)
Other income (loss), net9,468 (41,257)22,241 (81,657)
Income before income taxes$358,707 $308,803 $1,134,951 $964,064 
 
(1)Other segment items for the Company's U.S. dialysis segment include equity income from nonconsolidated joint ventures for all periods presented.
(2)Includes depreciation and amortization of $20,828 and $21,249 for the three months ended September 30, 2026 and 2025, respectively, and $64,834 and $58,723 for the nine months ended September 30, 2026 and 2025, respectively.
Expenditures for property and equipment by reportable segment were as follows:
Nine months ended September 30,
20262025
U.S. dialysis$355,773 $349,646 
Other—Ancillary services75,550 80,788 
$431,323 $430,434