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Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2017 | Jun. 30, 2016 | Jun. 30, 2017 | Jun. 30, 2016
Segment Reporting Information [Line Items] |  |  |  |
Depreciation and amortization | $ 200,038 | $ 180,381 | $ 390,244 | $ 349,736
U.S. dialysis and related lab services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Depreciation and amortization | 130,002 | 119,350 | 255,030 | 235,887
DMG |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Depreciation and amortization | 60,011 | 54,211 | 117,334 | 100,473
Ancillary services and strategic initiatives |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Depreciation and amortization | $ 10,025 | $ 6,820 | $ 17,880 | $ 13,376

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- Definition The current period expense charged against earnings on long-lived, physical assets not used in production, and which are not intended for resale, to allocate or recognize the cost of such assets over their useful lives; or to record the reduction in book value of an intangible asset over the benefit period of such asset; or to reflect consumption during the period of an asset that is not used in production. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 360 -SubTopic 10 -Section 50 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=6391035&loc=d3e2868-110229 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=66902209&loc=d3e3602-108585 + Details
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- Definition Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table. + References No definition available. + Details
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