Segment reporting

3 Months Ended

Mar. 31, 2025

Segment Reporting [Abstract]

Segment Reporting Disclosure

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.

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 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 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. See Note 24 to the Company's consolidated financial statements included in the 2024 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 (loss), and a reconciliation of segment operating margin (loss) to consolidated income before income taxes:

	Three months ended March 31,
	2025		2024
Segment revenues:
U.S. dialysis
Patient service revenues:
External sources	$	2,805,427	$	2,725,575
Intersegment revenues	11,734		24,463
U.S. dialysis patient service revenues	2,817,161		2,750,038
Other revenues
External sources	6,008		6,122
Total U.S. dialysis revenues	2,823,169		2,756,160
Other—Ancillary services
Patient service revenues	297,566		215,957
Other external sources	114,528		122,901
Intersegment revenues	2,728		2,747
Total ancillary services	414,822		341,605
Total net segment revenues	3,237,991		3,097,765
Elimination of intersegment revenues	(14,462)		(27,210)
Consolidated revenues	$	3,223,529	$	3,070,555
Significant segment expenses:
U.S. dialysis
Patient care costs	$	1,913,428	$	1,824,579
General and administrative	282,679		274,562
Depreciation and amortization	156,899		172,852
Other segment items(1)	(5,609)		(41,570)
U.S. dialysis segment expenses	2,347,397		2,230,423
Other - Ancillary services expenses	417,631		353,107
Segment operating margin (loss):
U.S. dialysis	475,772		525,737
Other—Ancillary services(2)	(2,809)		(11,502)
Total segment operating margin (loss)	472,963		514,235
Reconciliation of segment operating income to consolidated income before income taxes:
Corporate administrative support	(34,026)		(30,390)
Consolidated operating income	438,937		483,845
Debt expense	(135,055)		(99,418)
Other loss, net	(17,549)		(12,641)
Income from continuing operations before income taxes	$	286,333	$	371,786

(1)Other segment items for our U.S. dialysis segment include equity income from nonconsolidated joint ventures and a gain on changes in ownership interests.

(2)Includes depreciation and amortization of $19,552 and $14,231 for the three months ended March 31, 2025 and 2024, respectively.

Expenditures for property and equipment by reportable segment were as follows:

	Three months ended March 31,
	2025		2024
U.S. dialysis	$	113,591	$	104,953
Other—Ancillary services	29,667		16,062
	$	143,258	$	121,015