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Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014
Cash flows from operating activities: |  |  |
Net income | $ 1,033,082 | $ 427,410 | $ 863,330
Changes in operating assets and liabilities and non-cash items included in net income | 930,362 | 1,129,790 | 596,077
Net cash provided by operating activities | 1,963,444 | 1,557,200 | 1,459,407
Cash flows from investing activities: |  |  |
Additions of property and equipment | (829,095) | (707,998) | (641,330)
Acquisitions | (563,856) | (96,469) | (272,094)
Proceeds from asset sales, net of cash divested | 64,725 |  |
Proceeds from asset and business sales | 64,725 | 19,715 | 8,791
Investments and other items | 126,558 | (97,032) | (373,096)
Net cash used in investing activities | (1,201,668) | (881,784) | (1,277,729)
Cash flows from financing activities: |  |  |
Long-term debt and related financing costs, net | (124,442) | 619,698 | (7,989)
Other items | (1,227,539) | (758,668) | (156,990)
Net cash used in financing activities | (1,351,981) | (138,970) | (164,979)
Effect of exchange rate changes on cash | 4,276 | (2,571) | 2,293
Net (decrease) increase in cash and cash equivalents | (585,929) | 533,875 | 18,992
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | 946,249
Cash and cash equivalents at end of the year | 913,187 | 1,499,116 | 965,241
Additional Reporting Entities | DaVita Inc. |  |  |
Cash flows from operating activities: |  |  |
Net income | 879,874 | 269,732 | 723,114
Changes in operating assets and liabilities and non-cash items included in net income | (614,642) | (146,531) | (597,992)
Net cash provided by operating activities | 265,232 | 123,201 | 125,122
Cash flows from investing activities: |  |  |
Additions of property and equipment | (139,303) | (115,269) | (51,374)
Investments and other items | 153,031 | (74,474) | (333,803)
Net cash used in investing activities | 13,728 | (189,743) | (385,177)
Cash flows from financing activities: |  |  |
Long-term debt and related financing costs, net | (92,460) | 640,009 | 4,513
Intercompany borrowing | 237,988 | 486,588 | 410,437
Other items | (1,061,203) | (572,295) | (58,207)
Net cash used in financing activities | (915,675) | 554,302 | 356,743
Net (decrease) increase in cash and cash equivalents | (636,715) | 487,760 | 96,688
Cash and cash equivalents at beginning of the year | 1,186,636 | 698,876 | 602,188
Cash and cash equivalents at end of the year | 549,921 | 1,186,636 | 698,876
Additional Reporting Entities | Guarantor Subsidiaries |  |  |
Cash flows from operating activities: |  |  |
Net income | 726,620 | 195,507 | 647,085
Changes in operating assets and liabilities and non-cash items included in net income | 335,166 | 688,106 | 120,772
Net cash provided by operating activities | 1,061,786 | 883,613 | 767,857
Cash flows from investing activities: |  |  |
Additions of property and equipment | (382,305) | (319,695) | (312,191)
Acquisitions | (472,413) | (76,983) | (228,569)
Proceeds from asset sales, net of cash divested | 70,342 |  |
Proceeds from asset and business sales |  | 19,715 | 8,791
Investments and other items | (29,038) | (2,144) | (316)
Net cash used in investing activities | (813,414) | (379,107) | (532,285)
Cash flows from financing activities: |  |  |
Long-term debt and related financing costs, net | (27,830) | (11,953) | (12,545)
Intercompany borrowing | (249,182) | (394,735) | (282,461)
Other items | (21,525) | (66,382) | (14,099)
Net cash used in financing activities | (298,537) | (473,070) | (309,105)
Net (decrease) increase in cash and cash equivalents | (50,165) | 31,436 | (73,533)
Cash and cash equivalents at beginning of the year | 109,357 | 77,921 | 151,454
Cash and cash equivalents at end of the year | 59,192 | 109,357 | 77,921
Additional Reporting Entities | Non-Guarantor Subsidiaries |  |  |
Cash flows from operating activities: |  |  |
Net income | 805,040 | 476,354 | 475,907
Changes in operating assets and liabilities and non-cash items included in net income | (168,614) | 74,032 | 90,521
Net cash provided by operating activities | 636,426 | 550,386 | 566,428
Cash flows from investing activities: |  |  |
Additions of property and equipment | (307,487) | (273,034) | (277,765)
Acquisitions | (91,443) | (19,486) | (43,525)
Proceeds from asset sales, net of cash divested | (5,617) |  |
Investments and other items | 2,565 | (20,414) | (38,977)
Net cash used in investing activities | (401,982) | (312,934) | (360,267)
Cash flows from financing activities: |  |  |
Long-term debt and related financing costs, net | (4,152) | (8,358) | 43
Intercompany borrowing | 11,194 | (91,853) | (127,976)
Other items | (144,811) | (119,991) | (84,684)
Net cash used in financing activities | (137,769) | (220,202) | (212,617)
Effect of exchange rate changes on cash | 4,276 | (2,571) | 2,293
Net (decrease) increase in cash and cash equivalents | 100,951 | 14,679 | (4,163)
Cash and cash equivalents at beginning of the year | 203,123 | 188,444 | 192,607
Cash and cash equivalents at end of the year | 304,074 | 203,123 | 188,444
Consolidation, Eliminations |  |  |
Cash flows from operating activities: |  |  |
Net income | (1,378,452) | (514,183) | (982,776)
Changes in operating assets and liabilities and non-cash items included in net income | $ 1,378,452 | $ 514,183 | $ 982,776

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