v3.26.3
Segment reporting (Tables)
 9 Months Ended
Sep. 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 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 
Summary of Expenditures for Property and Equipment by Reportable Segment
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