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.



                            Six
                          months
                           ended
                           June              Year ended December 31,
                            30,    --------------------------------------------
                           2000      1999       1998     1997    1996    1995
                          -------  ---------  -------- -------- ------- -------
                                 (in thousands, except for ratio data)
                                                      
Income (loss) before
 income taxes,
 extraordinary items and
 cumulative effect of a
 change in accounting
 principle............... $(7,097) $(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..........  67,647    110,797    84,003   29,082  13,670  12,921
  Interest portion of
   rental expense........   9,113     17,501    12,992    8,196   5,301   3,346
                          -------  ---------  -------- -------- ------- -------
    Total fixed charges..  76,760    128,298    96,995   37,278  18,971  16,267
                          -------  ---------  -------- -------- ------- -------
Earnings (loss) before
 income taxes,
 extraordinary items,
 cumulative effect of a
 change in accounting
 principle and fixed
 charges................. $69,663  $ (53,528) $145,636 $118,456 $73,534 $53,408
                          -------  ---------  -------- -------- ------- -------
Ratio of earnings to
 fixed charges...........    (a)        (b)       1.50     3.18    3.88    3.28
                          =======  =========  ======== ======== ======= =======

- --------
(a) Due to the Company's loss in the six months ended June 30, 2000, the ratio
    coverage was less than 1:1. The Company would have had to generate
    additional earnings of $7 million to achieve a coverage of 1:1.

(b) 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.