EXHIBIT 12.1

                        TOTAL RENAL CARE HOLDINGS, INC.

                      RATIO OF EARNINGS TO FIXED CHARGES

  The ratio of earnings to fixed charges is computed by dividing fixed charges
into earnings. Earnings is defined as pretax income from continuing operations
adjusted by adding fixed charges and excluding interest capitalized during the
period. Fixed charges means the total of interest expense and amortization of
financing costs, and the estimated interest component of rental expense on
operating leases.



                                            Year ended December 31,
                                  ----------------------------------------------
                                    1999         1998     1997    1996    1995
                                  ---------    -------- -------- ------- -------
                                     (in thousands, except for ratio data)
                                                          
Income before income taxes,
 extraordinary items and
 cumulative effect of a change
 in accounting principle........  $(181,826)   $ 48,641 $ 81,178 $54,563 $37,141
                                  ---------    -------- -------- ------- -------
Fixed charges:
  Interest expense and
   amortization of debt issuance
   costs and discounts on all
   indebtedness.................    110,797      84,003   29,082  13,670  12,921
  Interest portion of rental
   expense......................     17,501      12,992    8,196   5,301   3,346
                                  ---------    -------- -------- ------- -------
    Total fixed charges.........    128,298      96,995   37,278  18,971  16,267
                                  ---------    -------- -------- ------- -------
Earnings before income taxes,
 extraordinary items, cumulative
 effect of a change in
 accounting principle and fixed
 charges........................  $ (53,528)   $145,636 $118,456 $73,534 $53,408
                                  =========    ======== ======== ======= =======
Ratio of earnings to fixed
 charges........................           (a)     1.50     3.18    3.88    3.28
                                  =========    ======== ======== ======= =======

- --------
(a) Due to the Company's loss in 1999, the ratio coverage was less than 1:1.
    The Company would have had to generate additional earnings of $182 million
    to achieve a coverage of 1:1.