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Acquisitions - Additional Information (Detail)
$ in Thousands
 1 Months Ended 12 Months Ended
Nov. 23, 2015
USD ($)
Clinic
Provider
Aug. 17, 2015
USD ($)
Clinic
State
Patient
Dec. 31, 2012
Entity
Dec. 31, 2015
USD ($)
Entity
Dec. 31, 2014
USD ($)
Entity
Dec. 31, 2013
USD ($)
Entity
Business Acquisition [Line Items]            
Cash paid to acquire business       $ 96,469 $ 272,094 $ 310,394
Deferred purchase price obligations         $ 136 $ 209
Amortizable intangible assets acquired, weighted-average estimated useful lives       8 years 10 years 14 years
Goodwill deductible for tax purposes associated with acquisitions       $ 73,733 $ 175,247 $ 221,454
Additional cash consideration in the form of earn-out payments       29,050 $ 15,614  
Other Accrued Liabilities            
Business Acquisition [Line Items]            
Fair value of contingent earn-out consideration       29,050    
Other long-term liabilities            
Business Acquisition [Line Items]            
Fair value of contingent earn-out consideration       5,085    
Other companies            
Business Acquisition [Line Items]            
Additional cash consideration in the form of earn-out payments       129,626    
Fair value of contingent earn-out consideration       $ 34,135    
Customer relationships            
Business Acquisition [Line Items]            
Amortizable intangible assets acquired, weighted-average estimated useful lives         10 years 17 years
Noncompetition agreements            
Business Acquisition [Line Items]            
Amortizable intangible assets acquired, weighted-average estimated useful lives       8 years 8 years 9 years
Minimum | Other companies | EBITDA operating income performance targets or quality margins            
Business Acquisition [Line Items]            
Earn out consideration payment period       1 year    
Maximum | Other companies | EBITDA operating income performance targets or quality margins            
Business Acquisition [Line Items]            
Earn out consideration payment period       2 years    
Renal Ventures Limited, LLC            
Business Acquisition [Line Items]            
Renal ventures interest percentage in dialysis centers   100.00%        
Cash paid to acquire business   $ 415,000        
Number of dialysis clinics ventures operations | Clinic   36        
Number Of dialysis clinics venture operations states | State   6        
Number of dialysis clinic patients | Patient   2,400        
The Everett Clinic Medical Group (TEC)            
Business Acquisition [Line Items]            
Cash paid to acquire business $ 385,000          
Number of providers in primary and specialty | Provider 500          
The Everett Clinic Medical Group (TEC) | Minimum            
Business Acquisition [Line Items]            
Number of dialysis clinic patients | Clinic 315,000          
Other dialysis acquisitions            
Business Acquisition [Line Items]            
Cash paid to acquire business       $ 96,469 $ 272,094 $ 310,394
Number of businesses acquired | Entity     2      
Other dialysis acquisitions | U.S. dialysis and related lab services            
Business Acquisition [Line Items]            
Number of businesses acquired | Entity       6 18 26
Other dialysis acquisitions | Foreign Dialysis And Other Medical Businesses            
Business Acquisition [Line Items]            
Number of businesses acquired | Entity       21 7 38
Other dialysis acquisitions | Vascular access centers            
Business Acquisition [Line Items]            
Number of businesses acquired | Entity       3    
Other dialysis acquisitions | Maximum | HomeChoice Partners            
Business Acquisition [Line Items]            
Deferred purchase price obligations       $ 8,395 $ 23,781 $ 24,683