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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
Mar. 31, 2016
Mar. 31, 2015
Segment Reporting Information [Line Items]    
Patient service revenues $ 2,477,738 $ 2,271,815
Less: Provision for uncollectible accounts (109,205) (99,164)
Net patient service revenues 2,368,533 2,172,651
Other revenues 325,556 264,799
Total net operating revenues 3,581,136 3,287,965
Capitated revenues 887,047 850,515
Operating income (loss) 364,889 (64,156)
Corporate administrative support (6,921) (6,133)
Debt expense (102,884) (97,392)
Other income (loss), net 2,976 (533)
Income (loss) before income taxes 264,981 (162,081)
Operating Segments    
Segment Reporting Information [Line Items]    
Total net operating revenues 3,607,342 3,304,800
Operating income (loss) 371,810 (58,023)
Operating Segments | U.S. Dialysis And Related Lab Services    
Segment Reporting Information [Line Items]    
Patient service revenues 2,327,971 2,166,150
Less: Provision for uncollectible accounts (104,751) (97,477)
Net patient service revenues 2,223,220 2,068,673
Other revenues [1] 3,973 3,184
Total net operating revenues 2,227,193 2,071,857
Operating income (loss) 440,055 (104,489)
Operating Segments | U.S. Dialysis And Related Lab Services | External Sources    
Segment Reporting Information [Line Items]    
Patient service revenues 2,313,663 2,154,294
Operating Segments | U.S. Dialysis And Related Lab Services | Intersegment Revenue    
Segment Reporting Information [Line Items]    
Patient service revenues 14,308 11,856
Operating Segments | HealthCare Partners (HCP)    
Segment Reporting Information [Line Items]    
Net patient service revenues 108,238 80,210
Other revenues [2] 14,530 15,053
Total net operating revenues 988,858 927,772
Capitated revenues 866,019 832,472
Operating income (loss) (57,145) 60,294
Operating Segments | HealthCare Partners (HCP) | Intersegment Revenue    
Segment Reporting Information [Line Items]    
Other revenues 71 37
Operating Segments | Other Segments    
Segment Reporting Information [Line Items]    
Net patient service revenues 51,383 35,624
Other revenues 307,053 246,562
Total net operating revenues 391,291 305,171
Capitated revenues 21,028 18,043
Operating income (loss) (11,100) (13,828)
Operating Segments | Other Segments | Intersegment Revenue    
Segment Reporting Information [Line Items]    
Total net operating revenues 11,827 4,942
Intersegment Elimination    
Segment Reporting Information [Line Items]    
Total net operating revenues $ (26,206) $ (16,835)
[1] Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties or centers in which the Company owns a noncontrolling equity investment.
[2] Includes payments received for medical consulting services and management fees for providing management and administrative services to an unconsolidated joint venture that provides medical services in which the Company owns a 50% interest, as well as revenue related to the maintenance of existing physician networks.