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Goodwill (Tables)
 12 Months Ended
Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Carrying Value of Goodwill by Reportable Segments
Changes in the carrying value of goodwill by reportable segments were as follows:
 
U.S. dialysis
 
Other - Ancillary
services
 
Consolidated
Balance at December 31, 2017
$
6,144,761

 
$
465,518

 
$
6,610,279

Acquisitions
130,574

 
147,774

 
278,348

Divestitures
(331
)
 
(15,166
)
 
(15,497
)
Impairment charges
—

 
(3,106
)
 
(3,106
)
Foreign currency and other adjustments
—

 
(28,064
)
 
(28,064
)
Balance at December 31, 2018
$
6,275,004

 
$
566,956

 
$
6,841,960

Acquisitions
18,089

 
72,137

 
90,226

Impairment charges
—

 
(124,892
)
 
(124,892
)
Foreign currency and other adjustments
(5,993
)
 
(13,666
)
 
(19,659
)
Balance at December 31, 2019
$
6,287,100

 
$
500,535

 
$
6,787,635

 
 
 
 
 
 
Goodwill
$
6,287,100

 
$
653,870

 
$
6,940,970

Accumulated impairment charges
—

 
(153,335
)
 
(153,335
)
 
$
6,287,100

 
$
500,535

 
$
6,787,635
Schedule of Reporting Units Goodwill Balances
Reporting unit
 
Goodwill
balance
 
Carrying amount
coverage(1)
 
Sensitivities
Operating
income(2)
 
Discount
rate(3)
Germany kidney care
 
$
295,151

 
—
%
 
(1.3
)%
 
(11.0
)%
Brazil kidney care
 
$
88,551

 
4.4
%
 
(2.8
)%
 
(7.0
)%
 
 
(1)
Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date.
(2)
Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
(3)
Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.