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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 6 Months Ended
Jun. 30, 2016
Jun. 30, 2015
Jun. 30, 2016
Jun. 30, 2015
Segment Reporting Information [Line Items]        
Patient service revenues $ 2,570,654 $ 2,363,579 $ 5,048,392 $ 4,635,394
Less: Provision for uncollectible accounts (111,428) (105,965) (220,633) (205,129)
Net patient service revenues 2,459,226 2,257,614 4,827,759 4,430,265
Other revenues 360,599 310,814 686,155 575,613
Total net operating revenues 3,717,651 3,434,618 7,298,787 6,722,583
Capitated revenues 897,826 866,190 1,784,873 1,716,705
Operating income (loss) 329,070 480,548 693,959 416,392
Corporate administrative support (5,417) (3,425) (12,337) (9,558)
Debt expense (102,894) (104,248) (205,778) (201,640)
Debt redemption and refinancing charges   (48,072)   (48,072)
Other income, net 3,215 2,311 6,191 1,778
Income before income taxes 229,391 330,539 494,372 168,458
Operating Segments        
Segment Reporting Information [Line Items]        
Total net operating revenues 3,746,885 3,453,937 7,354,227 6,758,737
Operating income (loss) 334,487 483,973 706,296 425,950
Operating Segments | U.S. Dialysis And Related Lab Services        
Segment Reporting Information [Line Items]        
Patient service revenues 2,367,044 2,251,221 4,695,015 4,417,371
Less: Provision for uncollectible accounts (106,515) (101,304) (211,266) (198,781)
Net patient service revenues 2,260,529 2,149,917 4,483,749 4,218,590
Other revenues [1] 4,250 3,540 8,223 6,724
Total net operating revenues 2,264,779 2,153,457 4,491,972 4,225,314
Operating income (loss) 449,190 437,844 889,245 333,355
Operating Segments | U.S. Dialysis And Related Lab Services | External Sources        
Segment Reporting Information [Line Items]        
Patient service revenues 2,352,574 2,237,630 4,666,236 4,391,924
Operating Segments | U.S. Dialysis And Related Lab Services | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Patient service revenues 14,470 13,591 28,779 25,447
Operating Segments | HealthCare Partners (HCP)        
Segment Reporting Information [Line Items]        
Net patient service revenues 156,307 82,236 264,545 162,446
Other revenues [2] 29,095 35,326 43,625 50,379
Total net operating revenues 1,059,565 966,342 2,048,423 1,894,114
Capitated revenues 874,119 848,595 1,740,138 1,681,067
Operating income (loss) (102,059) 72,336 (159,204) 132,630
Operating Segments | HealthCare Partners (HCP) | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Other revenues 44 185 115 222
Operating Segments | Other Segments        
Segment Reporting Information [Line Items]        
Net patient service revenues 56,860 39,052 108,244 74,676
Other revenues 327,254 271,948 634,307 518,510
Total net operating revenues 422,541 334,138 813,832 639,309
Capitated revenues 23,707 17,595 44,735 35,638
Operating income (loss) (12,644) (26,207) (23,745) (40,035)
Operating Segments | Other Segments | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Total net operating revenues 14,720 5,543 26,546 10,485
Intersegment Elimination        
Segment Reporting Information [Line Items]        
Total net operating revenues $ (29,234) $ (19,319) $ (55,440) $ (36,154)
[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.