DaVita (DVA) 10-Q29 Oct 242024 Q3 Quarterly reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - shares shares in Millions	9 Months Ended
Document and Entity Information - shares shares in Millions	Sep. 30, 2024	Oct. 25, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	1-14106
Entity Registrant Name	DAVITA INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0354549
Entity Address, Address Line One	2000 16th Street
Entity Address, City or Town	Denver,
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80202
City Area Code	720
Local Phone Number	631-2100
Title of 12(b) Security	Common Stock, $0.001 par value
Trading Symbol	DVA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		82
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000927066
Current Fiscal Year End Date	--12-31

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Dialysis patient service revenues	$ 3,138,561	$ 2,951,950	$ 9,141,195	$ 8,602,669
Other revenues	125,029	169,382	379,672	391,731
Total revenues	3,263,590	3,121,332	9,520,867	8,994,400
Operating expenses:
Patient care costs	2,151,875	2,067,315	6,373,150	6,181,348
General and administrative	393,534	376,883	1,123,859	1,072,513
Depreciation and amortization	187,014	188,423	549,758	550,166
Equity investment income, net	(3,711)	(7,228)	(15,874)	(22,502)
Gain on changes in ownership interest	0	0	(35,147)	0
Total operating expenses	2,728,712	2,625,393	7,995,746	7,781,525
Operating income	534,878	495,939	1,525,121	1,212,875
Debt expense	(134,583)	(98,080)	(331,748)	(302,361)
Debt prepayment, extinguishment and modification costs	(10,081)	0	(19,813)	(7,962)
Other loss, net	(16,780)	(19,650)	(56,900)	(14,525)
Income before income taxes	373,434	378,209	1,116,660	888,027
Income tax expense	77,674	68,848	215,168	161,621
Net income	295,760	309,361	901,492	726,406
Less: Net income attributable to noncontrolling interests	(81,072)	(62,729)	(224,479)	(185,536)
Net income attributable to DaVita Inc.	$ 214,688	$ 246,632	$ 677,013	$ 540,870
Earnings per share attributable to DaVita Inc.:
Basic net income	$ 2.56	$ 2.70	$ 7.86	$ 5.95
Diluted net income	$ 2.50	$ 2.62	$ 7.66	$ 5.80
Weighted average shares for earnings per share:
Basic shares	83,721,000	91,322,000	86,123,000	90,937,000
Diluted shares	85,795,000	94,041,000	88,422,000	93,317,000

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Net income	$ 295,760	$ 309,361	$ 901,492	$ 726,406
Unrealized (losses) gains on interest rate cap agreements:
Unrealized (losses) gains	(21,576)	6,996	(2,340)	28,305
Reclassifications of net realized gains into net income	(1,870)	(21,198)	(45,539)	(55,895)
Unrealized gains (losses) on foreign currency translation:	56,202	(47,644)	(62,371)	27,878
Other comprehensive income (loss)	32,756	(61,846)	(110,250)	288
Total comprehensive income	328,516	247,515	791,242	726,694
Less: Comprehensive income attributable to noncontrolling interests	(81,072)	(62,729)	(224,479)	(185,536)
Comprehensive income attributable to DaVita Inc.	$ 247,444	$ 184,786	$ 566,763	$ 541,158

CONSOLIDATED BALANCE SHEETS (un

CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
ASSETS
Cash and Cash Equivalents, at Carrying Value	$ 1,070,775	$ 380,063
Restricted Cash and Cash Equivalents	87,869	84,571
Short-term investments	20,996	11,610
Accounts receivable, net	2,267,365	1,986,856
Inventories	128,999	143,105
Other receivables	359,485	422,669
Prepaid and other current assets	96,989	102,645
Income tax receivable	4,522	6,387
Total current assets	4,037,000	3,137,906
Property and equipment, net	2,939,620	3,073,533
Operating lease right-of-use assets	2,418,350	2,501,364
Intangible assets, net	197,854	203,224
Equity method and other investments	430,483	545,848
Long-term investments	33,844	47,890
Other long-term assets	218,956	271,253
Goodwill	7,227,630	7,112,560
Total assets	17,503,737	16,893,578
LIABILITIES AND EQUITY
Accounts payable	488,244	514,533
Other liabilities	927,530	828,878
Accrued compensation and benefits	806,149	752,598
Current portion of operating lease liabilities	404,540	394,399
Current portion of long-term debt	296,255	123,299
Income tax payable	21,268	28,507
Total current liabilities	2,943,986	2,642,214
Long-term operating lease liabilities	2,237,135	2,330,389
Long-term debt	9,260,331	8,268,334
Other long-term liabilities	183,030	183,074
Deferred income taxes	659,581	726,217
Total liabilities	15,284,063	14,150,228
Commitments and contingencies:
Noncontrolling interests subject to put provisions	1,633,011	1,499,288
Equity:
Preferred Stock, Value, Issued	0	0
Common Stock, Value, Issued	90	89
Additional paid-in capital	295,637	509,804
Retained earnings	1,275,301	598,288
Treasury Stock, Value	(1,021,979)	0
Accumulated other comprehensive loss	(162,334)	(52,084)
Total DaVita Inc. shareholders' equity	386,715	1,056,097
Noncontrolling interests not subject to put provisions	199,948	187,965
Total equity	586,663	1,244,062
Total liabilities and equity	$ 17,503,737	$ 16,893,578

CONSOLIDATED BALANCE SHEETS (_2

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Property and equipment, accumulated depreciation	$ 6,174,254	$ 5,759,514
Intangible assets, accumulated amortization	$ 29,374	$ 38,445
Preferred stock, par value (usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (usd per share)	$ 0.001
Common stock, shares authorized (in shares)	450,000,000
Common stock, shares issued (in shares)	90,132,000	88,824,000
Common stock, shares outstanding (in shares)	82,624,000	88,824,000

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities:
Net income	$ 901,492	$ 726,406
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	549,758	550,166
Loss on extinguishment of debt	12,527	7,132
Stock-based compensation expense	75,392	82,313
Deferred income taxes	(53,713)	(17,767)
Equity investment loss, net	91,100	40,121
Gain on changes in ownership interest	(35,147)	0
Other non-cash losses, net	24,159	1,633
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	(175,643)	118,148
Increase (Decrease) in Inventories	20,495	290
Other current assets	72,477	31,842
Other long-term assets	(12,858)	1,101
Accounts payable	(43,414)	(33,837)
Accrued compensation and benefits	27,314	65,279
Other current liabilities	35,646	10,822
Income taxes	(7,528)	(1,878)
Other long-term liabilities	(7,646)	(7,945)
Net cash provided by operating activities	1,474,411	1,573,826
Cash flows from investing activities:
Additions of property and equipment	(384,786)	(409,011)
Acquisitions	(161,210)	(7,990)
Proceeds from asset and business sales	17,937	24,907
Purchase of debt investments held-to-maturity	(15,319)	(30,419)
Purchase of other debt and equity investments	(8,784)	(6,693)
Proceeds from debt investments held-to-maturity	22,092	94,414
Proceeds from sale of other debt and equity investments	4,558	3,930
Purchase of equity method investments	(4,497)	(276,006)
Distributions from equity method investments	6,554	3,364
Net cash used in investing activities	(523,455)	(603,504)
Cash flows from financing activities:
Borrowings	6,623,634	2,468,335
Payments on long-term debt	(5,437,907)	(2,992,248)
Deferred and debt related financing costs	(46,011)	(53,466)
Purchase of treasury stock	(1,020,550)	0
Distributions to noncontrolling interests	(229,236)	(203,381)
Net payments related to stock purchases and awards	(112,496)	(41,155)
Contributions from noncontrolling interests	10,623	11,579
Proceeds from sales of additional noncontrolling interests	860	50,962
Purchases of noncontrolling interests	(40,751)	(7,875)
Net cash used in financing activities	(251,834)	(767,249)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(5,112)	3,063
Net increase in cash, cash equivalents and restricted cash	694,010	206,136
Cash, cash equivalents and restricted cash at beginning of the year	464,634	338,989
Cash, cash equivalents and restricted cash at end of the period	$ 1,158,644	$ 545,125

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) $ in Thousands	Total	Total	Non- controlling interests subject to put provisions	Common stock	Additional paid-in capital	Retained earnings	Treasury stock	Accumulated other comprehensive loss	Non- controlling interests not subject to put provisions
Temporary equity, starting balance at Dec. 31, 2022			$ 1,348,908
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			131,523
Distributions			(133,656)
Contributions			10,102
Partial purchases			(700)
Fair value remeasurements			89,226
Temporary equity, ending balance at Sep. 30, 2023			1,445,403
Beginning balance at Dec. 31, 2022		$ 712,326		$ 90	$ 606,935	$ 174,487	$ 0	$ (69,186)	$ 163,566
Common stock, Beginning balance (in shares) at Dec. 31, 2022				90,411,000
Treasury stock, beginning balance (in shares) at Dec. 31, 2022							0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		540,870				540,870			54,013
Other comprehensive income (loss)	$ 288	288						288
Stock award plan (in shares)				937,000
Stock award plan				$ 1
Stock award plan		(53,352)			(53,353)
Stock-settled stock-based compensation expense		80,579			80,579
Changes in noncontrolling interest from:
Distributions									(69,725)
Acquisitions and divestitures		13,077			13,077				30,776
Partial purchases		(5,361)			(5,361)				(32)
Fair value remeasurements		(89,226)			(89,226)
Ending balance at Sep. 30, 2023		1,199,201		$ 91	552,651	715,357	$ 0	(68,898)	180,075
Common stock, Ending balance (in shares) at Sep. 30, 2023				91,348,000
Treasury stock, ending balance (in shares) at Sep. 30, 2023							0
Changes in noncontrolling interest from:
Contributions									1,477
Temporary equity, starting balance at Jun. 30, 2023			1,423,549
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			44,572
Distributions			(52,382)
Contributions			4,493
Partial purchases
Fair value remeasurements			25,171
Temporary equity, ending balance at Sep. 30, 2023			1,445,403
Beginning balance at Jun. 30, 2023		1,017,444		$ 91	555,680	468,725	$ 0	(7,052)	188,626
Common stock, Beginning balance (in shares) at Jun. 30, 2023				91,271,000
Treasury stock, beginning balance (in shares) at Jun. 30, 2023							0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		246,632				246,632			18,157
Other comprehensive income (loss)	(61,846)	(61,846)						(61,846)
Stock award plan (in shares)				77,000
Stock award plan
Stock award plan		(4,750)			(4,750)
Stock-settled stock-based compensation expense		27,071			27,071
Changes in noncontrolling interest from:
Distributions									(26,821)
Partial purchases		(179)			(179)				(27)
Fair value remeasurements		(25,171)			(25,171)
Ending balance at Sep. 30, 2023		1,199,201		$ 91	552,651	715,357	$ 0	(68,898)	180,075
Common stock, Ending balance (in shares) at Sep. 30, 2023				91,348,000
Treasury stock, ending balance (in shares) at Sep. 30, 2023							0
Changes in noncontrolling interest from:
Contributions									140
Temporary equity, starting balance at Dec. 31, 2023			1,499,288
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			158,475
Distributions			(152,702)
Contributions			8,548
Partial purchases			(36,499)
Fair value remeasurements			155,901
Temporary equity, ending balance at Sep. 30, 2024			1,633,011
Beginning balance at Dec. 31, 2023	$ 1,244,062	1,056,097		$ 89	509,804	598,288	$ 0	(52,084)	187,965
Common stock, Beginning balance (in shares) at Dec. 31, 2023	88,824,000			88,824,000
Treasury stock, beginning balance (in shares) at Dec. 31, 2023	0						0
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		677,013				677,013			66,004
Other comprehensive income (loss)	$ (110,250)	(110,250)						(110,250)
Stock award plan (in shares)				1,308,000
Stock award plan				$ 1
Stock award plan		(127,700)			(127,701)
Stock-settled stock-based compensation expense		72,122			72,122
Changes in noncontrolling interest from:
Distributions									(76,534)
Acquisitions and divestitures		491			491				20,438
Partial purchases		(3,178)			(3,178)
Fair value remeasurements		(155,901)			(155,901)
Purchase of treasury stock		(1,021,979)					$ (1,021,979)
Purchase of treasury stock (in shares)							(7,508,000)
Ending balance at Sep. 30, 2024	$ 586,663	386,715		$ 90	295,637	1,275,301	$ (1,021,979)	(162,334)	199,948
Common stock, Ending balance (in shares) at Sep. 30, 2024	82,624,000			90,132,000
Treasury stock, ending balance (in shares) at Sep. 30, 2024	7,508,000						(7,508,000)
Changes in noncontrolling interest from:
Contributions									2,075
Temporary equity, starting balance at Jun. 30, 2024			1,574,840
Increase (Decrease) in Temporary Equity [Roll Forward]
Net income			56,417
Distributions			(79,621)
Contributions			2,420
Fair value remeasurements			78,955
Temporary equity, ending balance at Sep. 30, 2024			$ 1,633,011
Beginning balance at Jun. 30, 2024		632,900		$ 90	383,235	1,060,613	$ (615,948)	(195,090)	217,116
Common stock, Beginning balance (in shares) at Jun. 30, 2024				89,855,000
Treasury stock, beginning balance (in shares) at Jun. 30, 2024							(4,774,000)
Comprehensive Income (Loss), Net of Tax, Including Portion Attributable to Noncontrolling Interest [Abstract]
Net income attributable to DaVita Inc.		214,688				214,688			24,655
Other comprehensive income (loss)	$ 32,756	32,756						32,756
Stock award plan (in shares)				277,000
Stock award plan
Stock award plan		(34,002)			(34,002)
Stock-settled stock-based compensation expense		25,359			25,359
Changes in noncontrolling interest from:
Distributions									(42,405)
Fair value remeasurements		(78,955)			(78,955)
Purchase of treasury stock		(406,031)					$ (406,031)
Purchase of treasury stock (in shares)							(2,734,000)
Ending balance at Sep. 30, 2024	$ 586,663	$ 386,715		$ 90	$ 295,637	$ 1,275,301	$ (1,021,979)	$ (162,334)	199,948
Common stock, Ending balance (in shares) at Sep. 30, 2024	82,624,000			90,132,000
Treasury stock, ending balance (in shares) at Sep. 30, 2024	7,508,000						(7,508,000)
Changes in noncontrolling interest from:
Contributions									$ 582

Condensed consolidated interim

Condensed consolidated interim financial statements Condensed consolidated interim financial statements	9 Months Ended
	Sep. 30, 2024
Text Block [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Condensed consolidated interim financial statements The unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies, and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes, and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 (2023 10-K). Prior period classifications conform to the current period presentation.

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition	9 Months Ended
Revenue Recognition Revenue Recognition	Sep. 30, 2024
Text Block [Abstract]
Revenue Recognition [Text Block]	Revenue recognition The following tables summarize the Company's segment revenues by primary payor source: Three months ended September 30, 2024 Three months ended September 30, 2023 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,641,645 $ $ 1,641,645 $ 1,515,860 $ $ 1,515,860 Medicaid and Managed Medicaid 216,664 216,664 207,327 207,327 Other government 86,680 196,257 282,937 90,549 128,980 219,529 Commercial 954,807 58,648 1,013,455 965,331 68,192 1,033,523 Other revenues: Medicare and Medicare Advantage 104,217 104,217 137,149 137,149 Medicaid and Managed Medicaid (25) (25) 331 331 Commercial 3,735 3,735 16,063 16,063 Other (1) 6,204 13,496 19,700 6,239 11,832 18,071 Eliminations of intersegment revenues (16,140) (2,598) (18,738) (24,289) (2,232) (26,521) Total $ 2,889,860 $ 373,730 $ 3,263,590 $ 2,761,017 $ 360,315 $ 3,121,332 Nine months ended September 30, 2024 Nine months ended September 30, 2023 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 4,760,340 $ $ 4,760,340 $ 4,538,264 $ $ 4,538,264 Medicaid and Managed Medicaid 641,738 641,738 629,118 629,118 Other government 249,605 518,565 768,170 265,119 376,530 641,649 Commercial 2,833,263 191,212 3,024,475 2,676,758 183,578 2,860,336 Other revenues: Medicare and Medicare Advantage 304,760 304,760 317,624 317,624 Medicaid and Managed Medicaid 816 816 1,296 1,296 Commercial 20,875 20,875 20,888 20,888 Other (1) 18,224 44,165 62,389 18,822 38,108 56,930 Eliminations of intersegment revenues (53,528) (9,168) (62,696) (66,698) (5,007) (71,705) Total $ 8,449,642 $ 1,071,225 $ 9,520,867 $ 8,061,383 $ 933,017 $ 8,994,400 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses. There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets.

Earnings per share (Notes)

Earnings per share (Notes)	9 Months Ended
Earnings per share (Notes)	Sep. 30, 2024
Earnings Per Share [Abstract]
Earnings Per Share [Text Block]	Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Net income attributable to DaVita Inc. $ 214,688 $ 246,632 $ 677,013 $ 540,870 Weighted average shares outstanding: Basic shares 83,721 91,322 86,123 90,937 Assumed incremental from stock plans 2,074 2,719 2,299 2,380 Diluted shares 85,795 94,041 88,422 93,317 Basic net income per share attributable to DaVita Inc. $ 2.56 $ 2.70 $ 7.86 $ 5.95 Diluted net income per share attributable to DaVita Inc. $ 2.50 $ 2.62 $ 7.66 $ 5.80 Anti-dilutive stock-settled awards excluded from calculation (1) 11 271 135 615 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equity

Investments in debt and equity securities	9 Months Ended
Investments in debt and equity securities	Sep. 30, 2024
Investments, Debt and Equity Securities [Abstract]
Investments in debt and equity securities	Short-term and long-term investments The Company’s short-term and long-term investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: September 30, 2024 December 31, 2023 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 15,296 $ — $ 15,296 $ 22,109 $ — $ 22,109 Investments in mutual funds and common stocks — 39,544 39,544 — 37,391 37,391 $ 15,296 $ 39,544 $ 54,840 $ 22,109 $ 37,391 $ 59,500 Short-term investments $ 15,296 $ 5,700 $ 20,996 $ 7,110 $ 4,500 $ 11,610 Long-term investments — 33,844 33,844 14,999 32,891 47,890 $ 15,296 $ 39,544 $ 54,840 $ 22,109 $ 37,391 $ 59,500 Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. Typically, any long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at September 30, 2024 and December 31, 2023. Equity securitie s. Substantially all of the Company's short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.

Goodwill

Goodwill	9 Months Ended
Goodwill	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 25,723 25,723 Impairment charges — (26,083) (26,083) Foreign currency and other adjustments — 36,310 36,310 Balance at December 31, 2023 6,416,825 695,735 7,112,560 Acquisitions 102,082 37,524 139,606 Divestitures (1,687) (1,506) (3,193) Foreign currency and other adjustments — (21,343) (21,343) Balance at September 30, 2024 $ 6,517,220 $ 710,410 $ 7,227,630 Balance at September 30, 2024: Goodwill $ 6,517,220 $ 860,669 $ 7,377,889 Accumulated impairment charges — (150,259) (150,259) $ 6,517,220 $ 710,410 $ 7,227,630 The Company did not recognize any goodwill impairment charges during the nine months ended September 30, 2024 and 2023.

Equity Method and Other Investm

Equity Method and Other Investments	9 Months Ended
Equity Method and Other Investments	Sep. 30, 2024
Investments, Debt and Equity Securities [Abstract]
Equity Method Investments and Joint Ventures Disclosure	Equity method and other investments The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: September 30, 2024 December 31, 2023 Mozarc Medical Holding LLC $ 238,572 $ 324,711 APAC joint venture 66,833 98,865 Other equity method partnerships 103,303 107,282 Adjusted cost method and other investments 21,775 14,990 $ 430,483 $ 545,848 During the nine months ended September 30, 2024 and 2023 the Company recognized equity investment income of $15,874 and $22,502, respectively, from its equity method investments in nonconsolidated dialysis partnerships. The Company also recognized equity investment losses from other equity method investments of $(86,821) and $(38,653) in other loss, net during the nine months ended September 30, 2024 and 2023, respectively. See Note 8 to the Company's consolidated financial statements included in the 2023 10-K for further description of the Company's equity method investments.

Long-term debt

Long-term debt	9 Months Ended
Long-term debt	Sep. 30, 2024
Debt Disclosure [Abstract]
Long-term debt	Long-term debt Long-term debt comprised the following: As of September 30, 2024 September 30, December 31, 2023 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 2,289,022 $ 1,234,375 4/28/2028 Base +1.75% (2) $ 2,277,577 Term Loan B-1 — 2,603,786 8/12/2026 $ — Extended Term Loan B-1 1,640,251 5/9/2031 SOFR + 2.00% $ 1,638,201 Revolving line of credit — — 4/28/2028 Base +1.75% (2) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,622,813 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,350,000 6.875% Senior Notes 1,000,000 — 9/1/2032 6.875 % $ 1,035,000 Acquisition obligations and other notes payable (3) 87,945 102,328 2024-2036 6.55 % $ 87,945 Financing lease obligations (4) 236,722 255,491 2025-2040 4.62 % CHC temporary funding assistance (5) 119,814 — % $ 119,814 Total debt principal outstanding 9,623,754 8,445,980 Discount, premium and deferred financing costs (6) (67,168) (54,347) 9,556,586 8,391,633 Less current portion (296,255) (123,299) $ 9,260,331 $ 8,268,334 (1) For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically using level 2 interest rate inputs. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement. (2) The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%. (3) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of September 30, 2024. (4) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (5) The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of September 30, 2024. (6) As of September 30, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $8,410 and deferred financing costs of $30,740, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $38,729 and increased by a debt premium of $10,711. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129. Scheduled maturities of long-term debt at September 30, 2024 were as follows: 2024 (remainder of the year) $ 163,416 2025 $ 177,412 2026 $ 187,944 2027 $ 204,790 2028 $ 1,924,071 2029 $ 41,185 Thereafter $ 6,924,936 On May 9, 2024 (the Fourth Amendment Effective Date), the Company entered into the Fourth Amendment (the Fourth Amendment) to its senior secured credit agreement dated as of August 12, 2019 (as amended, restated, supplemented or otherwise modified from time to time, the Credit Agreement). The Fourth Amendment modified the Credit Agreement to, among other things, extend the maturity date for a portion of its Term Loan B-1 in the aggregate principal amount of $911,598 and extend an additional incremental principal amount of $728,653 (together, referred to as the Extended Term Loan B-1). The Company used the incremental proceeds from the Extended Term Loan B-1 to prepay a proportionate amount of the principal balance still outstanding on its Term Loan B-1. The Extended Term Loan B-1 bears interest at the Company’s option, based on (i) the Base Rate (as defined below) plus the Applicable Margin (as defined below), or (ii) the forward-looking term rate based on the secured overnight financing rate that is published by CME Group Benchmark Administration Limited (Term SOFR) plus the Applicable Margin. The “Base Rate” is defined as the highest of (i) the Federal Funds Rate, as published by the Federal Reserve Bank of New York, plus 0.50%, (ii) the prime commercial lending rate of Wells Fargo as established from time to time and (iii) Term SOFR for an interest period of one month plus 1.00%; provided that if Term SOFR or the Base Rate is less than 0.00% such rate shall be deemed to be 0.00% for purposes of the Credit Agreement. The “Applicable Margin” for the Extended Term Loan B-1 is 2.00% in the case of Term SOFR loans, and 1.00% in the case of Base Rate loans. The Extended Term Loan B-1 requires quarterly principal payments beginning on December 31, 2024 of 0.25% of the aggregate principal amount of the Extended Term Loan B-1 outstanding on the Fourth Amendment Effective Date, with the balance due on May 9, 2031. As a result of the Fourth Amendment transaction described above, the Company recognized debt prepayment, extinguishment and modification costs of $9,732 in the second quarter of 2024 comprised partially of fees incurred for this transaction and partially of deferred financing costs and original issue discount written off for the portion of debt considered extinguished and reborrowed as a result of the Fourth Amendment. For the portion of the debt that was considered extinguished and reborrowed, the Company recognized constructive financing cash outflows and financing cash inflows on the statement of cash flows of $6,302 and $728,653 for the Extended Term Loan B-1, respectively, and constructive financing cash outflows of $722,351 for the prepayment of a portion of Term Loan B-1, even though no funds were actually paid or received. Another $13,282 of the debt considered extinguished related to the Extended Term Loan B-1 represented a non-cash financing activity. On August 13, 2024, the Company entered into the Sixth Amendment (the Sixth Amendment) to the Credit Agreement. The Sixth Amendment modified the Credit Agreement to extend an additional incremental principal amount of $1,100,000 on its Term Loan A-1 (together with the existing Term Loan A-1 balance, referred to as the Increased Term Loan A-1). The Sixth Amendment also incorporated the provisions of the Fifth Amendment to the Credit Agreement, dated as of August 7, 2024, which removed a cap on the amount of incremental term "A" loans the Company can incur under the Credit Agreement. The Company used a portion of the net proceeds from this transaction along with the net proceeds from the issuance of 6.875% Senior Notes due 2032, described below, to prepay the remainder of the balance outstanding on its Term Loan B-1 maturing 2026 in the amount of $949,819, the balance outstanding on its revolving line of credit and related accrued interest and fees. The remaining borrowings added cash to the balance sheet for general corporate purposes. The Increased Term Loan A-1 bears interest at Term SOFR, plus a CSA of 0.10% and an interest rate margin which is subject to adjustment depending upon the Company's leverage ratio under the Credit Agreement, and which can range from 1.25% to 2.25%, provided that this adjusted rate shall never be less than 0.00%. The Increased Term Loan A-1 requires amortizing quarterly principal payments that began on September 30, 2024 of $29,728 per quarter through June 30, 2027, and $44,591 per quarter from September 30, 2027 through March 31, 2028, with the balance due on April 28, 2028. As a result of the Sixth Amendment transaction described above, the Company recognized debt prepayment, extinguishment and modification costs of $10,081 in the third quarter of 2024 comprised partially of fees incurred for this transaction and partially of deferred financing costs and original issue discount written off for the extinguishment of the Term Loan B-1. Additionally, $861,282 of the debt considered extinguished and reborrowed related to the Increased Term Loan A-1 represented a non-cash financing activity. Borrowings under the Company's senior secured credit facilities are guaranteed and secured by substantially all of DaVita Inc.'s and certain of the Company’s domestic subsidiaries' assets and rank senior to all unsecured indebtedness. Borrowings under the Term Loan A-1, Extended Term Loan B-1 and revolving line of credit rank equal in priority for that security and related subsidiary guarantees. The Credit Agreement contains certain customary affirmative and negative covenants such as various restrictions or limitations on permitted amounts of investments (including acquisitions), share repurchases, payment of dividends, and redemptions and incurrence of other indebtedness. Many of these restrictions and limitations will not apply as long as the Company’s leverage ratio calculated in accordance with the Credit Agreement is below 4.00:1.00. In addition, the Credit Agreement requires compliance with a maximum leverage ratio covenant, tested quarterly, of 5.00:1.00 through June 30, 2026 and 4.50:1.00 thereafter (subject to an increase to 5.00:1.00 during the four fiscal quarters following a material acquisition). On August 13, 2024, the Company issued $1,000,000 aggregate principal amount of 6.875% senior notes due 2032 (the 6.875% Senior Notes) in a private offering pursuant to Rule 144A and Regulation S under the Securities Act of 1933, as amended. The 6.875% Senior Notes pay interest on March 1 and September 1 of each year beginning March 1, 2025 and mature on September 1, 2032. The 6.875% Senior Notes are unsecured senior obligations and rank equally in right of payment with the Company's existing and future unsecured senior indebtedness. The 6.875% Senior Notes are guaranteed by each of the Company’s domestic subsidiaries that guarantee its senior secured credit facilities. The Company may redeem up to 40% of the aggregate principal amount of the 6.875% Senior Notes at any time prior to September 1, 2027 at 106.875% of the aggregate principal amount from the proceeds of one or more equity offerings, plus accrued and unpaid interest. On and after September 1, 2027, the Company may at its option redeem the 6.875% Senior Notes, in whole or from time to time in part, at certain redemption prices specified in the indenture governing these notes plus accrued and unpaid interest. If the Company experiences certain change of control events, the Company must offer to repurchase all of the 6.875% Senior Notes (unless otherwise redeemed) at a price equal to 101% of the principal amount thereof, plus accrued and unpaid interest. The 6.875% Senior Notes contain restrictive covenants that limit the ability of the Company and the subsidiary guarantors of the 6.875% Senior Notes to, among other things and subject to certain exceptions and qualifications, create certain liens, enter into certain sale/leaseback transactions, or merge with or into, or convey, transfer or lease all or substantially all of their assets. The 6.875% Senior Notes and related subsidiary guarantees do not have any registration or similar rights and are not expected to be registered for exchange on public markets. As of September 30, 2024, the Company incurred $11,187 in fees and other professional expenses associated with this transaction that were capitalized and will amortize over the term of the 6.875% Senior Notes. In addition to the prepayment of Term Loan B-1, as described above, during the first nine months of 2024, the Company made regularly scheduled principal payments under its senior secured credit facilities totaling $45,353 on Term Loan A-1 and $13,716 on Term Loan B-1. On March 1, 2024, Change Healthcare (CHC), a subsidiary of UnitedHealth Group, launched a temporary assistance funding program (CHC Funding) to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of CHC's services. Under the program, CHC provides funding to providers for amounts that would otherwise have been received (with certain limitations), but for the disruption in processing electronic claims as a result of the outage. Amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by CHC and the Company. CHC has restored claims submission functionality and the Company has resumed claims submissions and billing processes through CHC’s information technology systems. Through a combination of CHC's platform and certain alternate billing processes, the Company is current on its primary claims submissions, but does continue to see delays in collections with some payors. As of September 30, 2024, the remaining CHC Funding amount outstanding was $119,814. The Company's 2019 interest rate cap agreements expired on June 30, 2024 and a portion of the Company's 2023 cap agreements became effective on or prior to June 30, 2024, as detailed in the table below. As of September 30, 2024, the effective portion of the Company's 2023 interest rate cap agreements have the economic effect of capping the Company's maximum exposure to SOFR variable interest rate changes on equivalent amounts of the Company's floating rate debt, including all of Extended Term Loan B-1 and a portion of Term Loan A-1. The remaining $429,273 outstanding principal balance of Term Loan A-1 is subject to SOFR-based interest rate volatility. These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. During 2024 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2024 cap agreements). These 2024 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2024 cap agreements do not contain credit-risk contingent features and become effective and expire as described in the table below. The following table summarizes the Company’s interest rate cap agreements outstanding during the nine months ended September 30, 2024: Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date Notional reduction or contractual maturity date 2024 (1) 2025 2026 2027 2019 $ 3,500,000 2.00% 6/30/2020 $ 3,500,000 2023 $ 1,000,000 3.75% 6/30/2024 $ 500,000 $ 500,000 2023 $ 1,000,000 4.00% (2) 6/30/2024 $ 250,000 $ 750,000 2023 $ 1,000,000 4.75% (3) 6/30/2024 $ 250,000 $ 750,000 2023 $ 500,000 5.00% (4) 6/30/2024 $ 500,000 2023 $ 250,000 4.50% 12/31/2024 $ 250,000 2023 $ 750,000 4.00% 12/31/2024 $ 250,000 $ 500,000 2024 $ 1,000,000 4.50% (5) 12/31/2025 $ 500,000 $ 500,000 2024 $ 750,000 4.00% (6) 12/31/2025 $ 250,000 $ 500,000 (1) The Company's 2019 cap agreements matured on June 30, 2024. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (3) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps. (4) Effective January 1, 2025, the maximum rate of 5.00% decreases to 4.50% for these interest rate caps. (5) Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps. (6) Effective December 31, 2026, the maximum rate of 4.00% increases to 4.25% for these interest rate caps. The fair value of the Company's interest rate cap agreements, which are classified in other long-term assets on its consolidated balance sheet, was $17,312 and $79,805 as of September 30, 2024 and December 31, 2023, respectively. See Note 10 for further details on amounts reclassified from accumulated other comprehensive loss and recorded as debt expense (offset) related to the Company’s interest rate cap agreements for the three and nine months ended September 30, 2024 and 2023. As a result of the variable rate cap from the Company's 2023 interest rate cap agreements, the Company’s weighted average effective interest rate on its senior secured credit facilities at the end of the third quarter of 2024 was 7.01%, based on the current margins in effect for its senior secured credit facilities as of September 30, 2024, as detailed in the table above. The Company’s weighted average effective interest rate on all debt, including the effect of interest rate caps and amortization of debt discount, for the three and nine months ended September 30, 2024 was 5.69% and 4.84% and as of September 30, 2024 was 5.71%. As of September 30, 2024, the Company’s interest rates were fixed and economically fixed on approximately 59% and 95% of its total debt, respectively. As of September 30, 2024, the Company had an undrawn revolving line of credit under its senior secured credit facilities of $1,500,000. Credit available under this revolving line of credit is reduced by the amount of any letters of credit outstanding under the facility, of which there were none as of September 30, 2024. The Company also had letters of credit of approximately $154,474 outstanding under a separate bilateral secured letter of credit facility as of September 30, 2024.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
Commitments and Contingencies	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Commitments and contingencies The Company operates in a highly regulated industry and is a party to various lawsuits, demands, claims, qui tam suits, governmental investigations (which frequently arise from qui tam suits) and audits (including, without limitation, investigations or other actions resulting from its obligation to self-report suspected violations of law) and other legal proceedings, including, without limitation, those described below. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of September 30, 2024 and December 31, 2023, the Company’s total recorded accruals with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including, without limitation, that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or may result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Certain Governmental Inquiries and Related Proceedings 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal healthcare offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries. In addition to DaVita Kidney Care, the matter included an investigation into DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In each of August 2018, May 2019, and July 2021, the Company received a Civil Investigative Demand (CID) pursuant to the False Claims Act from the U.S. Attorney's Office relating to this investigation. In May 2020, the Company sold its interest in Lifeline, but the Company retained certain liabilities of the Lifeline business, including those related to this investigation. On May 6, 2024, the Company finalized and executed a settlement agreement with the government and the relator in a qui tam matter that included a settlement amount of $34,487 for this matter. On May 7, 2024, the government notified the U.S. District Court, District of Colorado of its decision to intervene for purposes of settlement in the matter of U.S. ex rel. Kogod v. DaVita Inc., et al . The government and the relator agreed to voluntarily dismiss all substantive claims in the matter, and, on July 18, 2024, the District Court dismissed all claims except for the relator’s statutory claim for expenses, attorney’s fees, and costs. The Company disputes the relator’s request for expenses, attorney’s fees, and costs, and intends to defend accordingly. 2020 U.S. Attorney New Jersey Investigation : In March 2020, the U.S. Attorney’s Office, District of New Jersey served the Company with a subpoena and a CID relating to an investigation being conducted by that office and the U.S. Attorney’s Office, Eastern District of Pennsylvania. The subpoena and CID request information on several topics, including certain of the Company’s joint venture arrangements with physicians and physician groups, medical director agreements, and compliance with its five-year Corporate Integrity Agreement, the term of which expired October 22, 2019. In November 2022, the Company learned that, on April 1, 2022, the U.S. Attorney’s Office for the District of New Jersey notified the U.S. District Court for the District of New Jersey of its decision not to elect to intervene in the matter of U.S. ex rel. Doe v. DaVita Inc. and filed a Stipulation of Dismissal. On April 13, 2022, the U.S. District Court for the District of New Jersey dismissed the case without prejudice. On October 12, 2022, the U.S. Attorney’s Office for the Eastern District of Pennsylvania notified the U.S. District Court, Eastern District of Pennsylvania, of its decision not to elect to intervene at this time in the matter of U.S. ex rel. Bayne v. DaVita Inc., et al. The court then unsealed an amended complaint, which alleges violations of federal and state False Claims Acts, by order dated October 14, 2022. On November 8, 2023, the private party relator filed a fourth amended complaint. On November 29, 2023, the Company filed a motion to dismiss the fourth amended complaint. 2020 California Department of Insurance Investigation : In April 2020, the California Department of Insurance (CDI) sent the Company an Investigative Subpoena relating to an investigation being conducted by that office. CDI issued a superseding subpoena in September 2020 and an additional subpoena in September 2021. Those subpoenas request information on a number of topics, including but not limited to the Company’s communications with patients about insurance plans and financial assistance from the American Kidney Fund (AKF), analyses of the potential impact of patients’ decisions to change insurance providers, and documents relating to donations or contributions to the AKF. The Company is continuing to cooperate with CDI in this investigation. 2023 District of Columbia Office of Attorney General Investigation : In January 2023, the Office of the Attorney General for the District of Columbia issued a CID to the Company in connection with an antitrust investigation into the AKF. The CID covers the period from January 1, 2016 to the present. The CID requests information on a number of topics, including but not limited to the Company’s communications with the AKF, documents relating to donations to the AKF, and communications with patients, providers, and insurers regarding the AKF. The Company is cooperating with the government in this investigation. 2024 Federal Trade Commission Investigation : In April 2024, the Company received from the Federal Trade Commission (FTC) two CIDs in connection with an industry investigation under Section 5 of the Federal Trade Commission Act regarding the acquisition of Medical Director services and provision of dialysis services. The CIDs cover the period from January 1, 2016 to the present and generally seek information relating to restrictive covenants, such as non-competes, with physicians. The Company is cooperating with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and ongoing discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies, many of which relate to qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, an impact on the Company's various relationships and/or contracts related to the Company's business, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, members of its board of directors or management, possible criminal penalties, any of which could have a material adverse effect on the Company. Other Proceedings 2021 Antitrust Indictment and Putative Class Action Suit : On July 14, 2021, an indictment was returned by a grand jury in the U.S. District Court, District of Colorado against the Company and its former chief executive officer in the matter of U.S. v. DaVita Inc., et al. alleging that purported agreements entered into by DaVita's former chief executive officer not to solicit senior-level employees violated Section 1 of the Sherman Act. On April 15, 2022, a jury returned a verdict in the Company’s favor, acquitting both the Company and its former chief executive officer on all counts. On April 20, 2022, the court entered judgments of acquittal and closed the case. On August 9, 2021, DaVita Inc. and its former chief executive officer were added as defendants in a consolidated putative class action complaint in the matter of In re Outpatient Medical Center Employee Antitrust Litigation in the U.S. District Court, Northern District of Illinois. This class action complaint asserts that the defendants violated Section 1 of the Sherman Act and seeks to bring an action on behalf of certain groups of individuals employed by the Company between February 1, 2012 and January 5, 2021. On September 26, 2022, the court denied the Company's motion to dismiss. The Company disputes the allegations in the class action complaint, as well as the asserted violations of the Sherman Act, and intends to defend this action accordingly. Additionally, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including, without limitation, contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. * * * Other than as may be described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 8, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, may impact the Company's various relationships and/or contracts related to the Company's business or otherwise harm the Company’s business, results of operations, financial condition, cash flows or reputation. * * *
Noncontrolling interests subject to put provisions and other commitments	Other Commitments The Company also has certain potential commitments to provide working capital funding, if necessary, to certain nonconsolidated dialysis businesses that the Company manages and in which the Company owns a noncontrolling equity interest or which are wholly-owned by third parties of approximately $7,562.

Shareholders' equity

Shareholders' equity	9 Months Ended
Shareholders' equity	Sep. 30, 2024
Equity [Abstract]
Stock-based compensation	Shareholders' equity Stock-based compensation During the nine months ended September 30, 2024, the Company granted 723 stock-settled restricted and performance stock units with an aggregate grant-date fair value of $100,209 and a weighted average expected life of approximately 3.4 years. As of September 30, 2024, the Company had $154,712 in total estimated but unrecognized stock-based compensation expense under the Company's equity compensation and employee stock purchase plans. The Company expects to recognize this expense over a weighted average remaining period of 1.3 years.
Share repurchases	Share repurchases The following table summarizes the Company's common stock repurchases during the three and nine months ended September 30, 2024: Three months ended September 30, 2024 Nine months ended September 30, 2024 Shares repurchased Amount paid (1) Average price paid per share (2) Shares repurchased Amount paid (1) Average price paid per share (2) Open market repurchases: 2,734 $ 406,031 $ 147.20 7,508 $ 1,021,979 $ 134.98 (1) Includes commissions and the 1% excise tax imposed on certain stock repurchases made after December 31, 2022 by the Inflation Reduction Act of 2022. The excise tax is recorded as part of the cost basis of treasury stock repurchased and, as such, is included in stockholders’ equity. (2) Excludes commissions and the excise tax described above. Subsequent to September 30, 2024 through October 25, 2024, the Company repurchased 622 shares of its common stock for $101,017 at an average price paid of $160.77 per share. The Company did not repurchase any shares during the three and nine months ended September 30, 2023. Effective on December 17, 2021, the Board authorized a repurchase plan of $2,000,000. Effective on September 5, 2024, the Board increased the Company's existing authorization by $2,000,000 in additional repurchasing authority. This authorization allows the Company to make purchases from time to time in the open market or in privately negotiated transactions, including without limitation, through accelerated share repurchase transactions, derivative transactions, tender offers, Rule 10b5-1 plans or any combination of the foregoing, depending upon market conditions and other considerations. As of October 25, 2024, the Company has a total of $2,198,297, excluding excise taxes, available under the current authorization for additional share repurchases. Although this share repurchase authorization does not have an expiration date, the Company remains subject to share repurchase limitations, including under the terms of its senior secured credit facilities.

Accumulated other comprehensive

Accumulated other comprehensive (loss) income	9 Months Ended
Accumulated other comprehensive (loss) income	Sep. 30, 2024
Statement of Comprehensive Income [Abstract]
Comprehensive income	Accumulated other comprehensive loss Three months ended September 30, 2024 Nine months ended September 30, 2024 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 3,420 $ (198,510) $ (195,090) $ 27,853 $ (79,937) $ (52,084) Unrealized (losses) gains (28,748) 56,202 27,454 (3,116) (62,371) (65,487) Related income tax 7,172 — 7,172 776 — 776 (21,576) 56,202 34,626 (2,340) (62,371) (64,711) Reclassification into net income (2,493) — (2,493) (60,679) — (60,679) Related income tax 623 — 623 15,140 — 15,140 (1,870) — (1,870) (45,539) — (45,539) Ending balance $ (20,026) $ (142,308) $ (162,334) $ (20,026) $ (142,308) $ (162,334) Three months ended September 30, 2023 Nine months ended September 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 85,297 $ (92,349) $ (7,052) $ 98,685 $ (167,871) $ (69,186) Unrealized gains (losses) 9,319 (47,644) (38,325) 37,712 27,878 65,590 Related income tax (2,323) — (2,323) (9,407) — (9,407) 6,996 (47,644) (40,648) 28,305 27,878 56,183 Reclassification into net income (28,244) — (28,244) (74,475) — (74,475) Related income tax 7,046 — 7,046 18,580 — 18,580 (21,198) — (21,198) (55,895) — (55,895) Ending balance $ 71,095 $ (139,993) $ (68,898) $ 71,095 $ (139,993) $ (68,898) The interest rate cap agreement net realized gains reclassified into net income are recorded as debt expense in the corresponding consolidated statements of income. See Note 7 for further details.

Acquisitions and divestitures

Acquisitions and divestitures	9 Months Ended
Acquisitions and divestitures	Sep. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Acquisitions and divestitures	Acquisitions and divestitures During the nine months ended September 30, 2024 the Company acquired dialysis businesses as follows: Nine months ended September 30, 2024 Cash paid, net of cash acquired $ 161,210 Contingent earn-out obligations $ 296 Liabilities assumed $ 54,033 Fair value of previously held equity method investments $ 67,526 Number of dialysis centers acquired — U.S. 12 Number of dialysis centers acquired — International 91 Included in these transactions, the Company acquired a controlling interest in a previously nonconsolidated U.S. dialysis partnership for which it recognized a non-cash gain of $35,147 on its prior investment upon consolidation. The Company estimated the fair value of its previously held equity interests using appraisals developed with independent third party valuation firms. The assets and liabilities for these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. The initial purchase price allocations for these acquisitions have been recorded at estimated fair values based on information that was available to management and will be finalized when certain information arranged to be obtained is received. In particular, certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of intangibles, contingent earn-outs, property and equipment, leases, and certain other working capital items relating to these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Nine months ended September 30, 2024 Current assets $ 150,907 Property and equipment 46,738 Right-of-use lease assets and other long-term assets 51,491 Indefinite-lived licenses 10,722 Goodwill 139,606 Liabilities assumed (96,141) Noncontrolling interests assumed (20,258) $ 283,065 The amount of goodwill related to these acquisitions recognized or adjusted during the nine months ended September 30, 2024 that is deductible for tax purposes was $61,506.

Variable interest entities

Variable interest entities	9 Months Ended
Variable interest entities	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Variable interest entities	Variable interest entities (VIEs) At September 30, 2024, these condensed consolidated financial statements include total assets of VIEs of $294,071 and total liabilities and noncontrolling interests of VIEs to third parties of $125,404. There have been no material changes in the nature of the Company's arrangements with VIEs or its judgments concerning them from those described in Note 22 to the Company's consolidated financial statements included in the 2023 10-K.

Fair value of financial instrum

Fair value of financial instruments	9 Months Ended
Fair value of financial instruments	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair value of financial instruments	Fair values of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (redeemable equity interests classified as temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified assets, liabilities and temporary equities that are measured at fair value on a recurring basis into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of September 30, 2024: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 39,544 $ 39,544 Interest rate cap agreements $ 17,312 $ 17,312 Liabilities Contingent earn-out obligations for acquisitions $ 17,281 $ 17,281 Temporary equity Noncontrolling interests subject to put provisions $ 1,633,011 $ 1,633,011 Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stocks and are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 4 for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of September 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,599 if certain performance targets or quality margins are met over the next one year to five years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value. The estimated fair value of noncontrolling interests subject to put provisions is based principally on the higher of either estimated liquidation value of net assets or a multiple of earnings for each subject dialysis partnership, based on historical earnings, revenue mix, and other performance indicators that can affect future results. The multiples used for these valuations are derived from observed ownership transactions for dialysis businesses between unrelated parties in the U.S. in recent years, and the specific valuation multiple applied to each dialysis partnership is principally determined by its recent and expected revenue mix and contribution margin. As of September 30, 2024, an increase or decrease in the weighted average multiple used in these valuations of one times EBITDA would change the estimated fair value of these noncontrolling interests by approximately $220,000. See Notes 16 and 23 to the Company's consolidated financial statements included in the 2023 10-K for further discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. For a reconciliation of changes in noncontrolling interests subject to put provisions for the three and nine months ended September 30, 2024, see the consolidated statement of equity. The Company's fair value estimates for its senior secured credit facilities are based upon quoted bid and ask prices for these instruments, a level 2 input. For the Company's senior notes, fair value estimates are based on market level 1 inputs. See Note 7 for further discussion of the Company's debt. The book value of the Company's contingent consideration payable to Medtronic, Inc. for its interest in Mozarc Medical Holding LLC approximates its estimated fair value, which is based on level 3 inputs. Other financial instruments consist primarily of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, lease liabilities and debt. The balances of financial instruments other than debt and lease liabilities are presented in these condensed consolidated financial statements at September 30, 2024 at their approximate fair values due to the short-term nature of their settlements.

Segment reporting

Segment reporting	9 Months Ended
Segment reporting	Sep. 30, 2024
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. 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, its operations in each foreign sovereign jurisdiction, and its equity method investment in the Asia Pacific joint venture (APAC JV). 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 2023 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 to consolidated income before income taxes: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,883,656 $ 2,754,778 $ 8,431,418 $ 8,042,561 Intersegment revenues 16,140 24,289 53,528 66,698 U.S. dialysis patient service revenues 2,899,796 2,779,067 8,484,946 8,109,259 Other revenues: External sources 6,204 6,239 18,224 18,822 Total U.S. dialysis revenues 2,906,000 2,785,306 8,503,170 8,128,081 Other—Ancillary services Dialysis patient service revenues 254,905 197,172 709,777 560,108 Other external sources 118,825 163,143 361,448 372,909 Intersegment revenues 2,598 2,232 9,168 5,007 Total ancillary services revenues 376,328 362,547 1,080,393 938,024 Total net segment revenues 3,282,328 3,147,853 9,583,563 9,066,105 Elimination of intersegment revenues (18,738) (26,521) (62,696) (71,705) Consolidated revenues $ 3,263,590 $ 3,121,332 $ 9,520,867 $ 8,994,400 Segment operating margin (loss): U.S. dialysis $ 549,476 $ 509,135 $ 1,625,399 $ 1,330,992 Other—Ancillary services 13,906 28,098 (16,188) (18,372) Total segment operating margin 563,382 537,233 1,609,211 1,312,620 Reconciliation of segment operating income to consolidated Corporate administrative support (28,504) (41,294) (84,090) (99,745) Consolidated operating income 534,878 495,939 1,525,121 1,212,875 Debt expense (134,583) (98,080) (331,748) (302,361) Debt prepayment, extinguishment and modification costs (10,081) — (19,813) (7,962) Other loss, net (16,780) (19,650) (56,900) (14,525) Consolidated income before income taxes $ 373,434 $ 378,209 $ 1,116,660 $ 888,027 Depreciation and amortization expense by reportable segment was as follows: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 U.S. dialysis $ 170,543 $ 175,908 $ 503,805 $ 514,710 Other—Ancillary services 16,471 12,515 45,953 35,456 $ 187,014 $ 188,423 $ 549,758 $ 550,166 Expenditures for property and equipment by reportable segment were as follows: Nine months ended September 30, 2024 2023 U.S. dialysis $ 331,031 $ 363,895 Other—Ancillary services 53,755 45,116 $ 384,786 $ 409,011

New accounting standards

New accounting standards	9 Months Ended
New accounting standards	Sep. 30, 2024
Accounting Changes and Error Corrections [Abstract]
New Accounting Standards	New accounting standards New standards not yet adopted In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (ASU 2023-07) , which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The guidance also requires disclosure of the chief operating decision maker's (CODM) position for each segment and detail of how the CODM uses financial reporting to assess their segment’s performance. ASU 2023-07 is effective for all public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company has completed its initial assessment of the impact of this new guidance and does not expect it to have a material impact on the Company's consolidated financial statements. In December 2023, the Financial Accounting Standards Board issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , which expands income tax disclosure requirements to include additional information related to the rate reconciliation of effective tax rates to statutory rates, as well as additional disaggregation of taxes paid in both U.S. and foreign jurisdictions. The amendments in the ASU also remove disclosures related to certain unrecognized tax benefits and deferred taxes. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The amendments may be applied prospectively or retrospectively, and early adoption is permitted. The Company intends to adopt this ASU for the fiscal year ended December 31, 2025 and is still assessing the effect this guidance may have on its consolidated financial statement disclosures.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ 214,688	$ 246,632	$ 677,013	$ 540,870

Insider Trading Arrangements

Insider Trading Arrangements	9 Months Ended
Insider Trading Arrangements	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Condensed consolidated interi_2

Condensed consolidated interim financial statements Condensed consolidaed interim financial statements (Policies)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Condensed consolidated interim financial statements	Condensed consolidated interim financial statements The unaudited condensed consolidated interim financial statements included in this report are prepared by the Company. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies, and noncontrolling interests subject to put provisions. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, certain fair value estimates, accounting for income taxes, and loss contingencies. The results of operations reflected in these interim financial statements may not necessarily be indicative of annual operating results. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 (2023 10-K). Prior period classifications conform to the current period presentation.
Revenue	There are significant uncertainties associated with estimating revenue, many of which take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues, including determination of applicable primary and secondary coverage, changes in patient insurance coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. Dialysis patient service revenues. Revenues are recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Dialysis patient service revenues are recognized in the period services are provided based on these estimates. Revenues consist primarily of payments from government and commercial health plans for dialysis services provided to patients. Other revenues. Other revenues consist of revenues earned by the Company's non-dialysis ancillary services as well as fees for management and administrative services to outpatient dialysis businesses that the Company does not consolidate. Other revenues are estimated and recognized in the period the performance obligation is met, subject to applicable measurement constraints. The Company's integrated kidney care (IKC) revenues include revenues earned under risk-based arrangements, including value-based care (VBC) arrangements. Under its VBC arrangements, the Company assumes full or shared financial risk for the total medical cost of care for patients below or above a benchmark. The benchmarks against which the Company incurs profit or loss on these contracts are typically based on the underlying premiums paid to the insuring entity (the Company's counterparty), with adjustments where applicable, or on trended or adjusted medical cost targets. For its IKC business, the Company recognized revenues for performance obligations satisfied in previous years of $58,403 and $75,949 during the nine months ended September 30, 2024 and 2023, respectively. The delay in recognition of these amounts resulted predominantly from measurement limitations and recognition constraints on the Company's VBC contracts with health plans, many of which are complex and relatively new arrangements. Recognition of revenue from the Company's government Comprehensive Kidney Care Contracting (CKCC) program also have certain constraints for plan years 2023 and 2024. Measurements of revenue for the Company's IKC risk-based arrangements are complex, sensitive to a number of key inputs, and require meaningful estimates for a number of factors, including but not limited to member alignment data, third-party medical claims expense, outcomes on various quality metrics, and ultimate risk adjustment factor (RAF) scores. Information and other measurement limitations on these factors may constrain revenue recognition for a risk-based arrangement until a period after the Company's performance obligations have been met.
Earnings Per Share	Basic earnings per share is calculated by dividing net income attributable to the Company by the weighted average number of common shares outstanding. Weighted average common shares outstanding include restricted stock unit awards that are no longer subject to forfeiture because the recipients have satisfied either the explicit vesting terms or retirement eligibility requirements. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units as computed under the treasury stock method.
Short-term and Long-term Investments	Debt securities. The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. Typically, any long-term debt investments are bank time deposits with contractual maturities longer than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximated their fair values at September 30, 2024 and December 31, 2023. Equity securitie s. Substantially all of the Company's short-term and long-term equity investments are held within a trust to fund existing obligations associated with the Company’s non-qualified deferred compensation plans.
Long-term debt	These cap agreements are designated as cash flow hedges and, as a result, changes in their fair values are reported in other comprehensive income. The original premiums paid for the caps are amortized to debt expense on a straight-line basis over the term of each cap agreement starting from its effective date. These cap agreements do not contain credit risk-contingent features. During 2024 the Company entered into several forward interest rate cap agreements, described below, that have the economic effect of capping the Company's exposure to SOFR variable interest rate changes on specific portions of the Company's floating rate debt (2024 cap agreements). These 2024 cap agreements are designated as cash flow hedges and, as a result, changes in their fair values will be reported in other comprehensive income. These 2024 cap agreements do not contain credit-risk contingent features and become effective and expire as described in the table below.
Fair Value of Financial Instruments	Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of September 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,599 if certain performance targets or quality margins are met over the next one year to five years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value.
New Accounting Standards	New accounting standards New standards not yet adopted In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (ASU 2023-07) , which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The guidance also requires disclosure of the chief operating decision maker's (CODM) position for each segment and detail of how the CODM uses financial reporting to assess their segment’s performance. ASU 2023-07 is effective for all public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company has completed its initial assessment of the impact of this new guidance and does not expect it to have a material impact on the Company's consolidated financial statements. In December 2023, the Financial Accounting Standards Board issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures , which expands income tax disclosure requirements to include additional information related to the rate reconciliation of effective tax rates to statutory rates, as well as additional disaggregation of taxes paid in both U.S. and foreign jurisdictions. The amendments in the ASU also remove disclosures related to certain unrecognized tax benefits and deferred taxes. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The amendments may be applied prospectively or retrospectively, and early adoption is permitted. The Company intends to adopt this ASU for the fiscal year ended December 31, 2025 and is still assessing the effect this guidance may have on its consolidated financial statement disclosures.

Fair Value Measures and Disclos

Fair Value Measures and Disclosures (Policies)	9 Months Ended
Fair Value Measures and Disclosures (Policies)	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 7 for further discussion. As of September 30, 2024, the Company had contingent earn-out obligations associated with business acquisitions that could result in the Company paying the former owners a total of up to approximately $53,599 if certain performance targets or quality margins are met over the next one year to five years. The estimated fair value measurements of these contingent earn-out obligations are primarily based on unobservable inputs, including key financial metrics such as projected earnings before interest, taxes, depreciation, and amortization (EBITDA), revenue and other key performance indicators. The estimated fair values of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company's credit risk adjusted rate that is used to discount obligations to present value.

Revenue Recognition Segment rev

Revenue Recognition Segment revenue by major payor (Tables)	9 Months Ended
Revenue Recognition Segment revenue by major payor (Tables)	Sep. 30, 2024
Revenues by major payor [Abstract]
Disaggregation of Revenue [Table Text Block]	The following tables summarize the Company's segment revenues by primary payor source: Three months ended September 30, 2024 Three months ended September 30, 2023 U.S. dialysis Other — Ancillary services Consolidated U.S. dialysis Other — Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 1,641,645 $ $ 1,641,645 $ 1,515,860 $ $ 1,515,860 Medicaid and Managed Medicaid 216,664 216,664 207,327 207,327 Other government 86,680 196,257 282,937 90,549 128,980 219,529 Commercial 954,807 58,648 1,013,455 965,331 68,192 1,033,523 Other revenues: Medicare and Medicare Advantage 104,217 104,217 137,149 137,149 Medicaid and Managed Medicaid (25) (25) 331 331 Commercial 3,735 3,735 16,063 16,063 Other (1) 6,204 13,496 19,700 6,239 11,832 18,071 Eliminations of intersegment revenues (16,140) (2,598) (18,738) (24,289) (2,232) (26,521) Total $ 2,889,860 $ 373,730 $ 3,263,590 $ 2,761,017 $ 360,315 $ 3,121,332 Nine months ended September 30, 2024 Nine months ended September 30, 2023 U.S. dialysis Other - Ancillary services Consolidated U.S. dialysis Other - Ancillary services Consolidated Dialysis patient service revenues: Medicare and Medicare Advantage $ 4,760,340 $ $ 4,760,340 $ 4,538,264 $ $ 4,538,264 Medicaid and Managed Medicaid 641,738 641,738 629,118 629,118 Other government 249,605 518,565 768,170 265,119 376,530 641,649 Commercial 2,833,263 191,212 3,024,475 2,676,758 183,578 2,860,336 Other revenues: Medicare and Medicare Advantage 304,760 304,760 317,624 317,624 Medicaid and Managed Medicaid 816 816 1,296 1,296 Commercial 20,875 20,875 20,888 20,888 Other (1) 18,224 44,165 62,389 18,822 38,108 56,930 Eliminations of intersegment revenues (53,528) (9,168) (62,696) (66,698) (5,007) (71,705) Total $ 8,449,642 $ 1,071,225 $ 9,520,867 $ 8,061,383 $ 933,017 $ 8,994,400 (1) Consists primarily of management service fees in the Company's U.S. dialysis business and research fees, management fees, and other non-patient service revenues in the Other - ancillary services businesses.

Earnings per share Earnings Per

Earnings per share Earnings Per Share (Tables)	9 Months Ended
Earnings per share Earnings Per Share (Tables)	Sep. 30, 2024
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Net income attributable to DaVita Inc. $ 214,688 $ 246,632 $ 677,013 $ 540,870 Weighted average shares outstanding: Basic shares 83,721 91,322 86,123 90,937 Assumed incremental from stock plans 2,074 2,719 2,299 2,380 Diluted shares 85,795 94,041 88,422 93,317 Basic net income per share attributable to DaVita Inc. $ 2.56 $ 2.70 $ 7.86 $ 5.95 Diluted net income per share attributable to DaVita Inc. $ 2.50 $ 2.62 $ 7.66 $ 5.80 Anti-dilutive stock-settled awards excluded from calculation (1) 11 271 135 615 (1) Shares associated with stock awards excluded from the diluted denominator calculation because they were anti-dilutive under the treasury stock method.

Investments in debt and equit_2

Investments in debt and equity securities (Tables)	9 Months Ended
Investments in debt and equity securities (Tables)	Sep. 30, 2024
Investments, Debt and Equity Securities [Abstract]
Schedule of Investments	The Company’s short-term and long-term investments, consisting of debt instruments classified as held-to-maturity and equity investments with readily determinable fair values or redemption values, were as follows: September 30, 2024 December 31, 2023 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 15,296 $ — $ 15,296 $ 22,109 $ — $ 22,109 Investments in mutual funds and common stocks — 39,544 39,544 — 37,391 37,391 $ 15,296 $ 39,544 $ 54,840 $ 22,109 $ 37,391 $ 59,500 Short-term investments $ 15,296 $ 5,700 $ 20,996 $ 7,110 $ 4,500 $ 11,610 Long-term investments — 33,844 33,844 14,999 32,891 47,890 $ 15,296 $ 39,544 $ 54,840 $ 22,109 $ 37,391 $ 59,500

Goodwill (Tables)

Goodwill (Tables)	9 Months Ended
Goodwill (Tables)	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in Goodwill by Reportable Segments [Text Block]	Changes in the carrying value of goodwill by reportable segment were as follows: U.S. dialysis Other — Ancillary services Consolidated Balance at December 31, 2022 $ 6,416,825 $ 659,785 $ 7,076,610 Acquisitions — 25,723 25,723 Impairment charges — (26,083) (26,083) Foreign currency and other adjustments — 36,310 36,310 Balance at December 31, 2023 6,416,825 695,735 7,112,560 Acquisitions 102,082 37,524 139,606 Divestitures (1,687) (1,506) (3,193) Foreign currency and other adjustments — (21,343) (21,343) Balance at September 30, 2024 $ 6,517,220 $ 710,410 $ 7,227,630 Balance at September 30, 2024: Goodwill $ 6,517,220 $ 860,669 $ 7,377,889 Accumulated impairment charges — (150,259) (150,259) $ 6,517,220 $ 710,410 $ 7,227,630

Equity Method and Other Inves_2

Equity Method and Other Investments Equity Method and Other Investments (Tables)	9 Months Ended
	Sep. 30, 2024
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	The Company maintains equity method and other minor investments in the private securities of certain other healthcare and healthcare-related businesses as follows: September 30, 2024 December 31, 2023 Mozarc Medical Holding LLC $ 238,572 $ 324,711 APAC joint venture 66,833 98,865 Other equity method partnerships 103,303 107,282 Adjusted cost method and other investments 21,775 14,990 $ 430,483 $ 545,848

Long-term debt (Tables)

Long-term debt (Tables)	9 Months Ended
Long-term debt (Tables)	Sep. 30, 2024
Debt Disclosure [Abstract]
Long-term Debt	Long-term debt comprised the following: As of September 30, 2024 September 30, December 31, 2023 Maturity date Interest rate Estimated fair value (1) Senior Secured Credit Facilities: Term Loan A-1 $ 2,289,022 $ 1,234,375 4/28/2028 Base +1.75% (2) $ 2,277,577 Term Loan B-1 — 2,603,786 8/12/2026 $ — Extended Term Loan B-1 1,640,251 5/9/2031 SOFR + 2.00% $ 1,638,201 Revolving line of credit — — 4/28/2028 Base +1.75% (2) $ — Senior Notes: 4.625% Senior Notes 2,750,000 2,750,000 6/1/2030 4.625 % $ 2,622,813 3.75% Senior Notes 1,500,000 1,500,000 2/15/2031 3.75 % $ 1,350,000 6.875% Senior Notes 1,000,000 — 9/1/2032 6.875 % $ 1,035,000 Acquisition obligations and other notes payable (3) 87,945 102,328 2024-2036 6.55 % $ 87,945 Financing lease obligations (4) 236,722 255,491 2025-2040 4.62 % CHC temporary funding assistance (5) 119,814 — % $ 119,814 Total debt principal outstanding 9,623,754 8,445,980 Discount, premium and deferred financing costs (6) (67,168) (54,347) 9,556,586 8,391,633 Less current portion (296,255) (123,299) $ 9,260,331 $ 8,268,334 (1) For the Company's senior secured credit facilities, fair value estimates are based on bid and ask quotes, a level 2 input. For the Company's senior notes, fair value estimates are based on market level 1 inputs. For acquisition obligations and other notes payable, the carrying values presented here approximate their estimated fair values, based on estimates of their present values typically using level 2 interest rate inputs. For the CHC temporary funding assistance, the carrying value presented here approximates the estimated fair value based on the short-term nature of settlement. (2) The Company's senior secured credit facilities bear interest at Term SOFR, plus an interest rate margin, with certain portions also subject to a credit spread adjustment (CSA). Term SOFR plus CSA is referred to as "Base" in the table above. The Term Loan A-1 and revolving line of credit bear a CSA of 0.10%. (3) The interest rate presented for acquisition obligations and other notes payable is their weighted average interest rate based on the current fixed and variable interest rate components in effect as of September 30, 2024. (4) Financing lease obligations are measured at their approximate present values at inception. The interest rate presented is the weighted average discount rate embedded in financing leases outstanding. (5) The Change Healthcare (CHC) temporary funding assistance, as described below, is interest-free and amounts provided under this program are subject to repayment within 45 business days from a future date to be mutually agreed to by the parties. The balance is included in the Company's current portion of long-term debt as of September 30, 2024. (6) As of September 30, 2024, the carrying amount of the Company's senior secured credit facilities has been reduced by a discount of $8,410 and deferred financing costs of $30,740, and the carrying amount of the Company's senior notes has been reduced by deferred financing costs of $38,729 and increased by a debt premium of $10,711. As of December 31, 2023, the carrying amount of the Company's senior secured credit facilities was reduced by a discount of $2,487 and deferred financing costs of $32,498, and the carrying amount of the Company's senior notes was reduced by deferred financing costs of $31,491 and increased by a debt premium of $12,129.
Schedule of Derivative Instruments	The following table summarizes the Company’s interest rate cap agreements outstanding during the nine months ended September 30, 2024: Year cap agreements executed Notional amount SOFR maximum rate Approximate effective date Notional reduction or contractual maturity date 2024 (1) 2025 2026 2027 2019 $ 3,500,000 2.00% 6/30/2020 $ 3,500,000 2023 $ 1,000,000 3.75% 6/30/2024 $ 500,000 $ 500,000 2023 $ 1,000,000 4.00% (2) 6/30/2024 $ 250,000 $ 750,000 2023 $ 1,000,000 4.75% (3) 6/30/2024 $ 250,000 $ 750,000 2023 $ 500,000 5.00% (4) 6/30/2024 $ 500,000 2023 $ 250,000 4.50% 12/31/2024 $ 250,000 2023 $ 750,000 4.00% 12/31/2024 $ 250,000 $ 500,000 2024 $ 1,000,000 4.50% (5) 12/31/2025 $ 500,000 $ 500,000 2024 $ 750,000 4.00% (6) 12/31/2025 $ 250,000 $ 500,000 (1) The Company's 2019 cap agreements matured on June 30, 2024. (2) Effective January 1, 2025, the maximum rate of 4.00% decreases to 3.75% for these interest rate caps. (3) Effective January 1, 2025, the maximum rate of 4.75% decreases to 4.00% for these interest rate caps. (4) Effective January 1, 2025, the maximum rate of 5.00% decreases to 4.50% for these interest rate caps. (5) Effective December 31, 2026, the maximum rate of 4.50% increases to 4.75% for these interest rate caps. (6) Effective December 31, 2026, the maximum rate of 4.00% increases to 4.25% for these interest rate caps.

Accumulated other comprehensi_2

Accumulated other comprehensive (loss) income (Tables)	9 Months Ended
Accumulated other comprehensive (loss) income (Tables)	Sep. 30, 2024
Statement of Comprehensive Income [Abstract]
Comprehensive income	Three months ended September 30, 2024 Nine months ended September 30, 2024 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 3,420 $ (198,510) $ (195,090) $ 27,853 $ (79,937) $ (52,084) Unrealized (losses) gains (28,748) 56,202 27,454 (3,116) (62,371) (65,487) Related income tax 7,172 — 7,172 776 — 776 (21,576) 56,202 34,626 (2,340) (62,371) (64,711) Reclassification into net income (2,493) — (2,493) (60,679) — (60,679) Related income tax 623 — 623 15,140 — 15,140 (1,870) — (1,870) (45,539) — (45,539) Ending balance $ (20,026) $ (142,308) $ (162,334) $ (20,026) $ (142,308) $ (162,334) Three months ended September 30, 2023 Nine months ended September 30, 2023 Interest Foreign Accumulated Interest Foreign Accumulated Beginning balance $ 85,297 $ (92,349) $ (7,052) $ 98,685 $ (167,871) $ (69,186) Unrealized gains (losses) 9,319 (47,644) (38,325) 37,712 27,878 65,590 Related income tax (2,323) — (2,323) (9,407) — (9,407) 6,996 (47,644) (40,648) 28,305 27,878 56,183 Reclassification into net income (28,244) — (28,244) (74,475) — (74,475) Related income tax 7,046 — 7,046 18,580 — 18,580 (21,198) — (21,198) (55,895) — (55,895) Ending balance $ 71,095 $ (139,993) $ (68,898) $ 71,095 $ (139,993) $ (68,898)

Acquisitions and Divestitures (

Acquisitions and Divestitures (Tables)	9 Months Ended
Acquisitions and Divestitures (Tables)	Sep. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Schedule of Noncash or Part Noncash Acquisitions	During the nine months ended September 30, 2024 the Company acquired dialysis businesses as follows: Nine months ended September 30, 2024 Cash paid, net of cash acquired $ 161,210 Contingent earn-out obligations $ 296 Liabilities assumed $ 54,033 Fair value of previously held equity method investments $ 67,526 Number of dialysis centers acquired — U.S. 12 Number of dialysis centers acquired — International 91
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]	The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Nine months ended September 30, 2024 Current assets $ 150,907 Property and equipment 46,738 Right-of-use lease assets and other long-term assets 51,491 Indefinite-lived licenses 10,722 Goodwill 139,606 Liabilities assumed (96,141) Noncontrolling interests assumed (20,258) $ 283,065

Fair value of financial instr_2

Fair value of financial instruments (Tables)	9 Months Ended
Fair value of financial instruments (Tables)	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis	The following table summarizes the Company’s assets, liabilities and temporary equities measured at fair value on a recurring basis as of September 30, 2024: Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 39,544 $ 39,544 Interest rate cap agreements $ 17,312 $ 17,312 Liabilities Contingent earn-out obligations for acquisitions $ 17,281 $ 17,281 Temporary equity Noncontrolling interests subject to put provisions $ 1,633,011 $ 1,633,011

Segment reporting (Tables)

Segment reporting (Tables)	9 Months Ended
Segment reporting (Tables)	Sep. 30, 2024
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 (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Segment revenues: U.S. dialysis Dialysis patient service revenues: External sources $ 2,883,656 $ 2,754,778 $ 8,431,418 $ 8,042,561 Intersegment revenues 16,140 24,289 53,528 66,698 U.S. dialysis patient service revenues 2,899,796 2,779,067 8,484,946 8,109,259 Other revenues: External sources 6,204 6,239 18,224 18,822 Total U.S. dialysis revenues 2,906,000 2,785,306 8,503,170 8,128,081 Other—Ancillary services Dialysis patient service revenues 254,905 197,172 709,777 560,108 Other external sources 118,825 163,143 361,448 372,909 Intersegment revenues 2,598 2,232 9,168 5,007 Total ancillary services revenues 376,328 362,547 1,080,393 938,024 Total net segment revenues 3,282,328 3,147,853 9,583,563 9,066,105 Elimination of intersegment revenues (18,738) (26,521) (62,696) (71,705) Consolidated revenues $ 3,263,590 $ 3,121,332 $ 9,520,867 $ 8,994,400 Segment operating margin (loss): U.S. dialysis $ 549,476 $ 509,135 $ 1,625,399 $ 1,330,992 Other—Ancillary services 13,906 28,098 (16,188) (18,372) Total segment operating margin 563,382 537,233 1,609,211 1,312,620 Reconciliation of segment operating income to consolidated Corporate administrative support (28,504) (41,294) (84,090) (99,745) Consolidated operating income 534,878 495,939 1,525,121 1,212,875 Debt expense (134,583) (98,080) (331,748) (302,361) Debt prepayment, extinguishment and modification costs (10,081) — (19,813) (7,962) Other loss, net (16,780) (19,650) (56,900) (14,525) Consolidated income before income taxes $ 373,434 $ 378,209 $ 1,116,660 $ 888,027
Summary of Depreciation and Amortization Expense by Reportable Segment	Depreciation and amortization expense by reportable segment was as follows: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 U.S. dialysis $ 170,543 $ 175,908 $ 503,805 $ 514,710 Other—Ancillary services 16,471 12,515 45,953 35,456 $ 187,014 $ 188,423 $ 549,758 $ 550,166
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, 2024 2023 U.S. dialysis $ 331,031 $ 363,895 Other—Ancillary services 53,755 45,116 $ 384,786 $ 409,011

Revenue Recognition Segment R_2

Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Other revenues	$ 125,029	$ 169,382	$ 379,672	$ 391,731
Total revenues	3,263,590	3,121,332	9,520,867	8,994,400
Contract with Customer, Performance Obligation Satisfied in Previous Period			58,403	75,949
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(18,738)	(26,521)	(62,696)	(71,705)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,641,645	1,515,860	4,760,340	4,538,264
Other revenues	104,217	137,149	304,760	317,624
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	216,664	207,327	641,738	629,118
Other revenues	(25)	331	816	1,296
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	282,937	219,529	768,170	641,649
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,013,455	1,033,523	3,024,475	2,860,336
Other revenues	3,735	16,063	20,875	20,888
Other
Disaggregation of Revenue [Line Items]
Other revenues	19,700	18,071	62,389	56,930
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,889,860	2,761,017	8,449,642	8,061,383
U.S. dialysis \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(16,140)	(24,289)	(53,528)	(66,698)
U.S. dialysis \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,641,645	1,515,860	4,760,340	4,538,264
U.S. dialysis \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	216,664	207,327	641,738	629,118
U.S. dialysis \| Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	86,680	90,549	249,605	265,119
U.S. dialysis \| Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	954,807	965,331	2,833,263	2,676,758
U.S. dialysis \| Other
Disaggregation of Revenue [Line Items]
Other revenues	6,204	6,239	18,224	18,822
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	373,730	360,315	1,071,225	933,017
Other—Ancillary services \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(2,598)	(2,232)	(9,168)	(5,007)
Other—Ancillary services \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	104,217	137,149	304,760	317,624
Other—Ancillary services \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	(25)	331	816	1,296
Other—Ancillary services \| Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	196,257	128,980	518,565	376,530
Other—Ancillary services \| Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	58,648	68,192	191,212	183,578
Other revenues	3,735	16,063	20,875	20,888
Other—Ancillary services \| Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 13,496	$ 11,832	$ 44,165	$ 38,108

Earnings per share Earnings p_2

Earnings per share Earnings per share - Reconciliation of numerators and denominators used to calculate basic and diluted earnings per share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Numerators:
Net income attributable to DaVita Inc.	$ 214,688	$ 246,632	$ 677,013	$ 540,870
Weighted average basic shares outstanding during period	83,721,000	91,322,000	86,123,000	90,937,000
Assumed incremental from stock plans	2,074,000	2,719,000	2,299,000	2,380,000
Weighted average diluted shares outstanding during period	85,795,000	94,041,000	88,422,000	93,317,000
Basic net income per share attributable to DaVita Inc.	$ 2.56	$ 2.70	$ 7.86	$ 5.95
Diluted net income per share attributable to DaVita Inc.	$ 2.50	$ 2.62	$ 7.66	$ 5.80
Anti-dilutive stock-settled awards excluded from calculation	11,000	271,000	135,000	615,000

Investments in debt and equit_3

Investments in debt and equity securities (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Investment Holdings [Line Items]
Debt securities	$ 15,296	$ 22,109
Investments in equity securities	39,544	37,391
Equity Securities, FV-NI	39,544	37,391
Total	54,840	59,500
Debt securities, short-term investments	15,296	7,110
Short-term investments	20,996	11,610
Debt securities, long-term investments	0	14,999
Long-term investments	33,844	47,890
Certificates of deposit and other time deposits
Investment Holdings [Line Items]
Debt securities	15,296	22,109
Investments in equity securities	0	0
Total	15,296	22,109
Investments in mutual funds and common stocks
Investment Holdings [Line Items]
Debt securities	0	0
Investments in equity securities	39,544	37,391
Total	39,544	37,391
Short-term Investments
Investment Holdings [Line Items]
Investments in equity securities	5,700	4,500
Long-term Investments
Investment Holdings [Line Items]
Equity Securities, FV-NI, Noncurrent	$ 33,844	$ 32,891

Goodwill - Changes in Goodwill

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Goodwill [Roll Forward]
Beginning balance	$ 7,112,560	$ 7,076,610	$ 7,076,610
Acquisitions	139,606		25,723
Divestitures	(3,193)
Goodwill impairment charges	0	0	(26,083)
Foreign currency and other adjustments	(21,343)		36,310
Ending balance	7,227,630		7,112,560
Goodwill, before accumulated impairment charges	7,377,889
Accumulated impairment charges	(150,259)
Ending balance	7,227,630		7,112,560
U.S. dialysis
Goodwill [Roll Forward]
Beginning balance	6,416,825	6,416,825	6,416,825
Acquisitions	102,082		0
Divestitures	(1,687)
Goodwill impairment charges			0
Foreign currency and other adjustments	0		0
Ending balance	6,517,220		6,416,825
Goodwill, before accumulated impairment charges	6,517,220
Accumulated impairment charges	0
Ending balance	6,517,220		6,416,825
Other—Ancillary services
Goodwill [Roll Forward]
Beginning balance	695,735	$ 659,785	659,785
Acquisitions	37,524		25,723
Divestitures	(1,506)
Goodwill impairment charges			(26,083)
Foreign currency and other adjustments	(21,343)		36,310
Ending balance	710,410		695,735
Goodwill, before accumulated impairment charges	860,669
Accumulated impairment charges	(150,259)
Ending balance	$ 710,410		$ 695,735

Goodwill - Narrative (Details)

Goodwill - Narrative (Details) $ in Thousands	3 Months Ended	9 Months Ended		12 Months Ended
Goodwill - Narrative (Details) $ in Thousands	Sep. 30, 2024 segment	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Goodwill [Line Items]
Goodwill impairment charges \| $		$ 0	$ 0	$ (26,083)
Other Health Operations
Goodwill [Line Items]
Number of Reportable Segments \| segment	0

Equity Method and Other Inves_3

Equity Method and Other Investments Equity Method and Other Investments (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments	$ 430,483	$ 545,848
Mozarc Medical Holding LLC
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments	238,572	324,711
APAC joint venture
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments	66,833	98,865
Adjusted cost method and other investments
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments	21,775	14,990
Other equity method partnerships
Schedule of Equity Method and Other Investments [Line Items]
Equity method and other investments	$ 103,303	$ 107,282

Equity Method and Other Inves_4

Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.	$ 3,711	$ 7,228	$ 15,874	$ 22,502
Other Nonoperating Income (Expense)
Equity Method Investment income from equity method investments
Equity investment income (loss) from other equity method investments			(86,821)	(38,653)
Equity Method Investments In Nonconsolidated Dialysis Partnerships [Member]
Equity Method Investment income from equity method investments
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships.			$ 15,874	$ 22,502

Long-term debt (Detail)

Long-term debt (Detail) - USD ($) $ in Thousands				3 Months Ended		9 Months Ended
Long-term debt (Detail) - USD ($) $ in Thousands	Aug. 13, 2024	Aug. 07, 2024	May 09, 2024	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total debt principal outstanding				$ 9,623,754		$ 9,623,754	$ 8,445,980
Discount Premium And Deferred Financing Costs				(67,168)		(67,168)	(54,347)
Carrying amount of long-term debt, net of unamortized discounts				9,556,586		9,556,586	8,391,633
Less current portion				(296,255)		(296,255)	(123,299)
Total long-term debt				$ 9,260,331		$ 9,260,331	8,268,334
Debt interest rate during period				5.69%		4.84%
Long-term debt, weighted average interest rate, at point in time				5.71%		5.71%
Revolving line of credit
Debt Instrument [Line Items]
Secured Debt				$ 0		$ 0	0
Revolving line of credit, fair value of amount outstanding				0		$ 0
Debt Instrument, Maturity Date						Apr. 28, 2028
SOFR \| Revolving line of credit
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis						Base + 1.75%
4.625% Senior Notes
Debt Instrument [Line Items]
Senior Notes				2,750,000		$ 2,750,000	2,750,000
Debt Instrument, Fair Value Disclosure				2,622,813		$ 2,622,813
Debt interest rate during period						4.625%
Debt Instrument, Maturity Date						Jun. 01, 2030
3.75% Senior Notes
Debt Instrument [Line Items]
Senior Notes				1,500,000		$ 1,500,000	1,500,000
Debt Instrument, Fair Value Disclosure				1,350,000		$ 1,350,000
Debt interest rate during period						3.75%
Debt Instrument, Maturity Date						Feb. 15, 2031
6.875% Senior Notes
Debt Instrument [Line Items]
Senior Notes	$ 1,000,000			1,000,000		$ 1,000,000
Debt Instrument, Fair Value Disclosure				$ 1,035,000		$ 1,035,000
Debt interest rate during period	6.875%			6.875%
Debt Instrument, Payment Terms	The 6.875% Senior Notes pay interest on March 1 and September 1 of each year beginning March 1, 2025 and mature on September 1, 2032
Debt Instrument, Date of First Required Payment	Mar. 01, 2025
Debt Instrument, Maturity Date						Sep. 01, 2032
Debt Instrument, Redemption, Description	The Company may redeem up to 40% of the aggregate principal amount of the 6.875% Senior Notes at any time prior to September 1, 2027
Debt Instrument, Redemption Price, Percentage Any time Prior to September 1, 2027	106.875%
Debt Instrument, Redemption Price, Percentage On or After September 1, 2027	101%
Debt Instrument related fees, discounts, and other professional expenses	$ 11,187
Acquisition obligations and other notes payable
Debt Instrument [Line Items]
Acquisition obligations and other notes payable				$ 87,945		$ 87,945	102,328
Long-term debt, weighted average interest rate, at point in time				6.55%		6.55%
Acquisition obligations and other notes payable, fair value				$ 87,945		$ 87,945
Debt instrument, maturity date, description						2024-2036
Financing lease obligations
Debt Instrument [Line Items]
Financing lease obligations				$ 236,722		$ 236,722	255,491
Finance lease, weighted average discount rate, percent				4.62%		4.62%
Debt instrument, maturity date, description						2025-2040
Change Healthcare Temporary Funding Assistance
Debt Instrument [Line Items]
Debt interest rate during period						0%
CHC Temporary Funding Assistance				$ 119,814		$ 119,814
CHC Temporary Funding Assistance, Fair Value				$ 119,814		119,814
CHC Repayment Terms				within 45 business days of notice
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt				$ 2,289,022		2,289,022	1,234,375
Debt Instrument, Fair Value Disclosure				2,277,577		2,277,577
Debt Instrument, Periodic Payment, Principal						$ 45,353
Debt Instrument, Maturity Date						Apr. 28, 2028
Term Loan A-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis						Base + 1.75%
Increased Term Loan A-1
Debt Instrument [Line Items]
Proceeds from Issuance of Debt	$ 1,100,000
Debt Instrument, effective date	Aug. 13, 2024	Aug. 07, 2024
Changes to Terms of Debt Agreement		The Sixth Amendment also incorporated the provisions of the Fifth Amendment to the Credit Agreement, dated as of August 7, 2024, which removed a cap on the amount of incremental term "A" loans the Company can incur under the Credit Agreement.
Debt Instrument, Payment Terms	The Increased Term Loan A-1 requires amortizing quarterly principal payments that began on September 30, 2024 of $29,728 per quarter through June 30, 2027, and $44,591 per quarter from September 30, 2027 through March 31, 2028, with the balance due on April 28, 2028.
Debt Instrument, Frequency of Periodic Payment	quarterly
Debt Instrument, Date of First Required Payment	Sep. 30, 2024
Debt Instrument, Quarterly Payment Through June 30, 2027	$ 29,728
Debt Instrument, Quarterly Payment From September 30, 2027 Through March 31, 2028	$ 44,591
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid				1,828,245		$ 1,828,245
Debt Instrument, Maturity Date Range, Start	Sep. 30, 2024
Debt Instrument, Maturity Date Range, End	Apr. 28, 2028
Debt Instrument, Maturity Date	Apr. 28, 2028
Increased Term Loan A-1 \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin	0%
Increased Term Loan A-1 \| SOFR \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin	1.25%
Increased Term Loan A-1 \| SOFR \| Maximum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin	2.25%
Increased Term Loan A-1 \| Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin	0.10%
Term Loan B-1
Debt Instrument [Line Items]
Secured Debt				0		0	$ 2,603,786
Debt Instrument, Fair Value Disclosure				0		0
Debt Instrument, Periodic Payment, Principal						$ 13,716
Debt Instrument, Maturity Date						Aug. 12, 2026
Constructive Financing Cash Outflows					$ 722,351
Prepayment of Term Loan B 1	$ 949,819				728,653
Extended Term Loan B-1
Debt Instrument [Line Items]
Secured Debt				1,640,251		$ 1,640,251
Debt Instrument, Fair Value Disclosure				$ 1,638,201		$ 1,638,201
Debt Instrument, effective date			May 09, 2024
Debt Instrument, Payment Terms						The Extended Term Loan B-1 requires quarterly principal payments beginning on December 31, 2024 of 0.25% of the aggregate principal amount of the Extended Term Loan B-1 outstanding on the Fourth Amendment Effective Date, with the balance due on May 9, 2031.
Debt Instrument, Frequency of Periodic Payment						quarterly
Debt Instrument, Date of First Required Payment				Dec. 31, 2024
Debt Instrument, Quarterly Payment, % of Aggregate Principal Outstanding				0.25%		0.25%
Debt Instrument, Periodic Payment Terms, Balloon Payment to be Paid				$ 1,533,635		$ 1,533,635
Debt Instrument, Maturity Date Range, Start				Dec. 31, 2024
Debt Instrument, Maturity Date Range, End						May 09, 2031
Debt Instrument, Maturity Date						May 09, 2031
Constructive Financing Cash Outflows					$ 6,302
Extended Term Loan B-1 \| Minimum
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin				0%
Extended Term Loan B-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis				SOFR + 2.00%
Term Loan A-1 and Revolver \| Adjusted Rate
Debt Instrument [Line Items]
SOFR Plus Interest Rate Margin						0.10%

Long-term debt - Additional Inf

Long-term debt - Additional Information (Detail) $ in Thousands		3 Months Ended			9 Months Ended
	Aug. 13, 2024	Sep. 30, 2024 USD ($)	Jun. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end		5.71%			5.71%
Weighted average effective interest rate during quarter		5.69%			4.84%
Percentage of debt instruments bearing fixed interest rate		59%			59%
Long Term Debt Percentage Bearing Economically Fixed Interest Rate		95%			95%
Leverage Ratio Covenant		4			4
Leverage Ratio Covenant Through Jun 30, 2026		5			5
Leverage Ratio Covenant after Jun 30, 2026		4.50			4.50
Leverage Ratio Covenant after Jun 30, 2026 - Subject to Increase during four fiscal quarters following a material acquisition		5			5
Debt Prepayment, Extinguishment And Modification Costs		$ 10,081	$ 9,732	$ 0	$ 19,813	$ 7,962
3.75% Senior Notes
Debt Instrument [Line Items]
Weighted average effective interest rate during quarter					3.75%
6.875% Senior Notes
Debt Instrument [Line Items]
Weighted average effective interest rate during quarter	6.875%	6.875%
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end		7.01%			7.01%
Debt Instrument, Unamortized Discount		$ 8,410			$ 8,410		$ 2,487
Deferred Financing Costs		30,740			30,740		32,498
Senior Notes
Debt Instrument [Line Items]
Deferred Financing Costs		38,729			38,729		31,491
Debt Instrument, Unamortized Premium		10,711			10,711		$ 12,129
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt Outstanding Principal Balance Subject To SOFR		429,273			$ 429,273
Term Loan A-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis					Base + 1.75%
Increased Term Loan A-1
Debt Instrument [Line Items]
Other Significant Noncash Financing Activity		$ 861,282
Increased Term Loan A-1 \| Adjusted Rate
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin	0.10%
Increased Term Loan A-1 \| Maximum \| SOFR
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin	2.25%
Increased Term Loan A-1 \| Minimum
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin	0%
Increased Term Loan A-1 \| Minimum \| SOFR
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin	1.25%
Extended Term Loan B-1
Debt Instrument [Line Items]
Constructive Financing Cash Outflows			6,302
Constructive Financing Cash Inflow			728,653
Other Significant Noncash Financing Activity			13,282
Secured Debt, Extended Maturity			911,598
Extended Term Loan B 1 - Additional Incremental Principal			$ 728,653
Extended Term Loan B-1 \| Adjusted Rate \| Base Rate Loans
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin		1%
Extended Term Loan B-1 \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis		SOFR + 2.00%
Extended Term Loan B-1 \| SOFR \| SOFR Loans
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin		2%
Extended Term Loan B-1 \| Maximum \| 1-Month SOFR \| Base Rate Loans
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin		1%
Extended Term Loan B-1 \| Maximum \| Prime Rate \| Base Rate Loans
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis		prime commercial lending rate
Extended Term Loan B-1 \| Maximum \| Fed Funds Effective Rate Overnight Index Swap Rate \| Base Rate Loans
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin		0.50%
Extended Term Loan B-1 \| Minimum
Debt Instrument [Line Items]
Term SOFR or Base Rate Plus Interest Rate Margin		0%
Revolving line of credit
Line of Credit Facility [Line Items]
Maximum borrowing capacity on the revolving credit facilities		$ 1,500,000			$ 1,500,000
Revolving line of credit \| SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis					Base + 1.75%
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding		0			$ 0
Bilateral Secured Letter Of Credit Facility
Debt Instrument [Line Items]
Letters of credit outstanding		$ 154,474			$ 154,474

Long-Term Debt - Scheduled Matu

Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Debt Disclosure [Abstract]
2024 (remainder of the year)	$ 163,416
2025	177,412
2026	187,944
2027	204,790
2028	1,924,071
2029	41,185
Thereafter	$ 6,924,936

Long-term debt Schedule of Deri

Long-term debt Schedule of Derivative Instruments (Details) - USD ($) $ in Thousands			9 Months Ended
	Dec. 31, 2026	Jan. 01, 2025	Sep. 30, 2024	Dec. 31, 2023
2019 Interest Rate Cap Agreements Effective June 30, 2020
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2020
Derivative, Maturity date			Jun. 30, 2024
Notional Amount Amortizable By Maturity Date			$ 3,500,000
2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2024
Derivative, Maturity date			Dec. 31, 2025
Notional Amount Amortizable By Maturity Date			$ 500,000
Notional Amount Amortizable By December 31, 2024			$ 500,000
2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2024
Derivative, Maturity date			Dec. 31, 2025
Notional Amount Amortizable By Maturity Date			$ 750,000
Notional Amount Amortizable By December 31, 2024			$ 250,000
2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2024
Derivative, Maturity date			Dec. 31, 2025
Notional Amount Amortizable By Maturity Date			$ 750,000
Notional Amount Amortizable By December 31, 2024			$ 250,000
2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024
Derivative [Line Items]
Derivative, effective date			Jun. 30, 2024
Derivative, Maturity date			Dec. 31, 2026
Notional Amount Amortizable By Maturity Date			$ 500,000
2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024
Derivative [Line Items]
Derivative, effective date			Dec. 31, 2024
Derivative, Maturity date			Dec. 31, 2025
Notional Amount Amortizable By Maturity Date			$ 250,000
2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024
Derivative [Line Items]
Derivative, effective date			Dec. 31, 2024
Derivative, Maturity date			Dec. 31, 2026
Notional Amount Amortizable By Maturity Date			$ 500,000
Notional Amount Amortizable By December 31, 2025			$ 250,000
2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025
Derivative [Line Items]
Derivative, effective date			Dec. 31, 2025
Derivative, Maturity date			Dec. 31, 2027
Notional Amount Amortizable By Maturity Date			$ 500,000
Notional Amount Amortizable By December 31, 2026			$ 500,000
2024 Interest Rate Cap Agreements 4.00% Effective December 31 2025
Derivative [Line Items]
Derivative, effective date			Dec. 31, 2025
Derivative, Maturity date			Dec. 31, 2027
Notional Amount Amortizable By Maturity Date			$ 500,000
Notional Amount Amortizable By December 31, 2026			250,000
Other Long-term Assets \| Interest rate cap agreements
Derivative [Line Items]
Derivative asset, fair value, gross asset			17,312	$ 79,805
Term Loan Facility \| Maximum \| 2019 Interest Rate Cap Agreements Effective June 30, 2020
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 3,500,000
SOFR Plus Interest Rate Margin			2%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 3.75% Effective June 30 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			3.75%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			4%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.00% Effective June 30 2024 \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin		3.75%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			4.75%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.75% Effective June 30 2024 \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin		4%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 500,000
SOFR Plus Interest Rate Margin			5%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 5.00% Effective June 30 2024 \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin		4.50%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.50% Effective December 31 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 250,000
SOFR Plus Interest Rate Margin			4.50%
Term Loan Facility \| Maximum \| 2023 Interest Rate Cap Agreements 4.00% Effective December 31 2024
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 750,000
SOFR Plus Interest Rate Margin			4%
Term Loan Facility \| Maximum \| 2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 1,000,000
SOFR Plus Interest Rate Margin			4.50%
Term Loan Facility \| Maximum \| 2024 Interest Rate Cap Agreements 4.50% Effective December 31 2025 \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin	4.75%
Term Loan Facility \| Maximum \| 2024 Interest Rate Cap Agreements 4.00% Effective December 31 2025
Derivative [Line Items]
Notional amounts of interest rate agreements			$ 750,000
SOFR Plus Interest Rate Margin			4%
Term Loan Facility \| Maximum \| 2024 Interest Rate Cap Agreements 4.00% Effective December 31 2025 \| Subsequent Event
Derivative [Line Items]
SOFR Plus Interest Rate Margin	4.25%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands		9 Months Ended
	Oct. 22, 2019	Sep. 30, 2024
Commitments and Contingencies:
Corporate Integrity Agreement Period		5 years
Corporate Integrity Agreement Expiration Date	Oct. 22, 2019
Commitments to provide operating capital
Commitments and Contingencies:
Other potential commitments to provide operating capital to several dialysis centers		$ 7,562
2017 U S Attorney Colorado Investigation
Loss Contingencies [Line Items]
Litigation Settlement, Amount Awarded to Other Party		$ 34,487

Stock-based compensation (Detai

Stock-based compensation (Details) $ in Thousands	9 Months Ended
Stock-based compensation (Details) $ in Thousands	Sep. 30, 2024 USD ($) shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans	$ 154,712
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years)	1 year 3 months 18 days
Restricted stock units and Performance stock units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period \| shares	723,000
Aggregate grant-date fair value	$ 100,209
Weighted-average expected life (in years)	3 years 4 months 24 days

Share repurchases (Details)

Share repurchases (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	1 Months Ended	3 Months Ended	9 Months Ended
	Oct. 25, 2024	Sep. 30, 2024	Sep. 30, 2024	Sep. 30, 2023	Sep. 05, 2024	Dec. 17, 2021
Equity, Class of Treasury Stock [Line Items]
Stock Repurchase Program, Authorized Amount					$ 2,000,000	$ 2,000,000
Open Market Purchases
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)		2,734	7,508	0
Treasury Stock, Value, Acquired, Cost Method		$ 406,031	$ 1,021,979
Treasury Stock Acquired, Average Cost Per Share		$ 147.20	$ 134.98
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Stock Repurchase Program, Remaining Authorized Repurchase Amount	$ 2,198,297
Subsequent Event \| Open Market Purchases
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)	622
Treasury Stock, Value, Acquired, Cost Method	$ 101,017
Treasury Stock Acquired, Average Cost Per Share	$ 160.77

Related Party Transactions (Det

Related Party Transactions (Details) - Berkshire			3 Months Ended
Related Party Transactions (Details) - Berkshire	Oct. 25, 2024	Sep. 30, 2024	Sep. 30, 2024
Berkshire Share Repurchase Agreement			Berkshire share repurchase agreement On April 30, 2024, the Company entered into an agreement (the share repurchase agreement) with Berkshire Hathaway Inc. on behalf of itself and its affiliates (collectively, Berkshire). Under the share repurchase agreement, at any time Berkshire beneficially owns at least 45.0% of the issued and outstanding common stock of the Company in the aggregate, the Company shall repurchase from Berkshire, and Berkshire shall sell to the Company, on a quarterly basis, a number of shares of common stock sufficient to return Berkshire’s aggregate beneficial ownership to 45.0% of the Company's issued and outstanding common stock. The per share price the Company will pay Berkshire for any such share repurchase will be the volume-weighted average price per share paid by the Company for any shares of common stock repurchased by the Company from public stockholders pursuant to the Company’s share repurchase program during the applicable repurchase period. Under this agreement, repurchases of common stock by the Company from Berkshire will occur on the date that is two business days prior to the date of the Company’s regular quarterly or annual investor call to publicly report earnings; however, if at any time the Company determines that Berkshire beneficially owns or will beneficially own shares of common stock representing more than 49.5% of the issued and outstanding common stock in the aggregate, such determination will trigger immediate share repurchases under this agreement. As of September 30, 2024 and October 25, 2024, Berkshire beneficially owned less than 45.0% of the outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date.
Repurchase Agreement, Date			Apr. 30, 2024
Related Party Transaction, Terms and Manner of Settlement			two business days prior to the date of the Company’s regular quarterly or annual investor call to publicly report earnings
Owns Beneficially At Least In Aggregate			Berkshire beneficially owns at least 45.0%
Trigger Immediate Share Repurchase			Berkshire beneficially owns or will beneficially own shares of common stock representing more than 49.5% of the issued and outstanding common stock in the aggregate, such determination will trigger immediate share repurchases under this agreement
Owns Beneficially as at date		As of September 30, 2024 and October 25, 2024, Berkshire beneficially owned less than 45.0% of the outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date.
Subsequent Event
Owns Beneficially as at date	As of September 30, 2024 and October 25, 2024, Berkshire beneficially owned less than 45.0% of the outstanding common stock of the Company and, as a result, no repurchase obligation exists at either date.

Accumulated other comprehensi_3

Accumulated other comprehensive (loss) income (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance			$ (52,084)
Ending balance	$ (162,334)		(162,334)
Interest rate cap agreements
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	3,420	$ 85,297	27,853	$ 98,685
Unrealized gains (losses)	(28,748)	9,319	(3,116)	37,712
Related income tax benefit	7,172	(2,323)	776	(9,407)
Unrealized (losses) gains net	(21,576)	6,996	(2,340)	28,305
Reclassification into net income	(2,493)	(28,244)	(60,679)	(74,475)
Related income tax	623	7,046	15,140	18,580
Reclassification from accumulated other comprehensive income into net income net of tax	(1,870)	(21,198)	(45,539)	(55,895)
Ending balance	(20,026)	71,095	(20,026)	71,095
Foreign currency translation adjustments
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(198,510)	(92,349)	(79,937)	(167,871)
Unrealized gains (losses)	56,202	(47,644)	(62,371)	27,878
Related income tax benefit	0	0	0	0
Unrealized (losses) gains net	56,202	(47,644)	(62,371)	27,878
Reclassification into net income	0	0	0	0
Related income tax	0	0	0	0
Reclassification from accumulated other comprehensive income into net income net of tax	0	0	0	0
Ending balance	(142,308)	(139,993)	(142,308)	(139,993)
Accumulated other comprehensive (loss) income
AOCI Including Portion Attributable to Noncontrolling Interest, Net of Tax [Roll Forward]
Beginning balance	(195,090)	(7,052)	(52,084)	(69,186)
Unrealized gains (losses)	27,454	(38,325)	(65,487)	65,590
Related income tax benefit	7,172	(2,323)	776	(9,407)
Unrealized (losses) gains net	34,626	(40,648)	(64,711)	56,183
Reclassification into net income	(2,493)	(28,244)	(60,679)	(74,475)
Related income tax	623	7,046	15,140	18,580
Reclassification from accumulated other comprehensive income into net income net of tax	(1,870)	(21,198)	(45,539)	(55,895)
Ending balance	$ (162,334)	$ (68,898)	$ (162,334)	$ (68,898)

Acquisitions and divestitures A

Acquisitions and divestitures Assets And Liabilities Assumed (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill	$ 7,227,630	$ 7,112,560	$ 7,076,610
Goodwill deductible for tax purposes associated with acquisitions	61,506
Dialysis and other businesses
Business Acquisition [Line Items]
Current assets	150,907
Property and equipment	46,738
Right-of-use lease assets and other long-term assets	51,491
Indefinite-lived licenses	10,722
Goodwill	139,606
Liabilities assumed	(96,141)
Noncontrolling interests assumed	(20,258)
Total assets acquired and liabilities assumed	283,065
U.S. dialysis
Business Acquisition [Line Items]
Goodwill	$ 6,517,220	$ 6,416,825	$ 6,416,825

Acquisitions and divestitures_2

Acquisitions and divestitures (Details) $ in Thousands	3 Months Ended		9 Months Ended
Acquisitions and divestitures (Details) $ in Thousands	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) Clinic	Sep. 30, 2023 USD ($)
Business Acquisition [Line Items]
Cash paid to acquire businesses			$ 161,210	$ 7,990
Gain on changes in ownership interest	$ 0	$ 0	35,147	$ 0
Dialysis and other businesses
Business Acquisition [Line Items]
Cash paid to acquire businesses			161,210
Business Combination Contingent Consideration Acquisitions			296
Deferred purchase price obligations			54,033
Business Combination, Step Acquisition, Equity Interest in Acquiree, Fair Value			67,526
Gain on changes in ownership interest			$ 35,147
Dialysis and other businesses \| U.S. dialysis
Business Acquisition [Line Items]
Number of businesses acquired \| Clinic			12
Dialysis and other businesses \| Foreign Dialysis Centers
Business Acquisition [Line Items]
Number of businesses acquired \| Clinic			91

Variable interest entities - Ad

Variable interest entities - Additional Information (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Total assets	$ 17,503,737	$ 16,893,578
Total liabilities and noncontrolling interests	15,284,063	$ 14,150,228
Variable Interest Entity
Total assets	294,071
Total liabilities and noncontrolling interests	$ 125,404

Fair value of financial instr_3

Fair value of financial instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Assets
Investments in equity securities	$ 39,544	$ 37,391
Fair Value, Measurements, Recurring
Assets
Investments in equity securities	39,544
Liabilities
Contingent earn-out obligations	17,281
Temporary equity
Noncontrolling interests subject to put provisions	1,633,011
Fair Value, Measurements, Recurring \| Interest rate cap agreements
Assets
Interest rate cap agreements	17,312
Fair Value, Measurements, Recurring \| Quoted prices in active markets for identical assets (Level 1)
Assets
Investments in equity securities	39,544
Liabilities
Contingent earn-out obligations
Temporary equity
Noncontrolling interests subject to put provisions
Fair Value, Measurements, Recurring \| Quoted prices in active markets for identical assets (Level 1) \| Interest rate cap agreements
Assets
Interest rate cap agreements
Fair Value, Measurements, Recurring \| Significant other observable inputs (Level 2)
Assets
Investments in equity securities
Liabilities
Contingent earn-out obligations
Temporary equity
Noncontrolling interests subject to put provisions
Fair Value, Measurements, Recurring \| Significant other observable inputs (Level 2) \| Interest rate cap agreements
Assets
Interest rate cap agreements	17,312
Fair Value, Measurements, Recurring \| Significant unobservable inputs (Level 3)
Assets
Investments in equity securities
Liabilities
Contingent earn-out obligations	17,281
Temporary equity
Noncontrolling interests subject to put provisions	1,633,011
Fair Value, Measurements, Recurring \| Significant unobservable inputs (Level 3) \| Interest rate cap agreements
Assets
Interest rate cap agreements

Fair value of financial instr_4

Fair value of financial instruments (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Potential Increase Decrease In Fair Value Of Noncontrolling Interests Due To Change In Weighted Average EBITDA Multiple	$ 220,000
Maximum
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Business Combination Contingent Consideration Acquisitions	$ 53,599
Maximum \| EBITDA or Operating Income Performance Targets or Quality Margins \| Other companies
Fair Value Net Derivative Asset Liability Measured On Recurring Basis Unobservable Input Reconciliation [Line Items]
Earn-out consideration payment period	5 years

Segment reporting - Summary of

Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Other revenues	$ 125,029		$ 169,382	$ 379,672	$ 391,731
Total revenues	3,263,590		3,121,332	9,520,867	8,994,400
Operating income (loss)	534,878		495,939	1,525,121	1,212,875
Corporate administrative support	(28,504)		(41,294)	(84,090)	(99,745)
Debt expense	(134,583)		(98,080)	(331,748)	(302,361)
Debt prepayment, extinguishment and modification costs	(10,081)	$ (9,732)	0	(19,813)	(7,962)
Other loss, net	(16,780)		(19,650)	(56,900)	(14,525)
Income before income taxes	373,434		378,209	1,116,660	888,027
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	2,889,860		2,761,017	8,449,642	8,061,383
Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	373,730		360,315	1,071,225	933,017
Operating Segments
Segment Reporting Information [Line Items]
Total revenues	3,282,328		3,147,853	9,583,563	9,066,105
Operating income (loss)	563,382		537,233	1,609,211	1,312,620
Operating Segments \| U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,899,796		2,779,067	8,484,946	8,109,259
Total revenues	2,906,000		2,785,306	8,503,170	8,128,081
Operating income (loss)	549,476		509,135	1,625,399	1,330,992
Operating Segments \| U.S. dialysis \| External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,883,656		2,754,778	8,431,418	8,042,561
Other revenues	6,204		6,239	18,224	18,822
Operating Segments \| U.S. dialysis \| Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	16,140		24,289	53,528	66,698
Operating Segments \| Other—Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues	254,905		197,172	709,777	560,108
Other revenues	118,825		163,143	361,448	372,909
Total revenues	376,328		362,547	1,080,393	938,024
Operating income (loss)	13,906		28,098	(16,188)	(18,372)
Operating Segments \| Other—Ancillary services \| Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues	2,598		2,232	9,168	5,007
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues	(18,738)		(26,521)	(62,696)	(71,705)
Intersegment Elimination \| U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues	(16,140)		(24,289)	(53,528)	(66,698)
Intersegment Elimination \| Other—Ancillary services
Segment Reporting Information [Line Items]
Total revenues	$ (2,598)		$ (2,232)	$ (9,168)	$ (5,007)

Segment reporting - Summary o_2

Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 187,014	$ 188,423	$ 549,758	$ 550,166
U.S. dialysis
Segment Reporting Information [Line Items]
Depreciation and amortization	170,543	175,908	503,805	514,710
Other—Ancillary services
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 16,471	$ 12,515	$ 45,953	$ 35,456

Segment reporting - Summary o_3

Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 384,786	$ 409,011
Segment, Expenditure, Addition to Long-Lived Assets	384,786	409,011
U.S. dialysis
Segment Reporting Information [Line Items]
Segment, Expenditure, Addition to Long-Lived Assets	331,031	363,895
Other—Ancillary services
Segment Reporting Information [Line Items]
Segment, Expenditure, Addition to Long-Lived Assets	$ 53,755	$ 45,116