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Summary of Expenditures for Property and Equipment 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] |  |  |  |
Expenditures for property and equipment | $ 184,405 | $ 185,440 | $ 398,940 | $ 358,627
U.S. dialysis and related lab services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Expenditures for property and equipment | 152,233 | 150,932 | 325,761 | 284,380
DMG |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Expenditures for property and equipment | 20,883 | 18,098 | 48,671 | 38,243
Ancillary services and strategic initiatives |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Expenditures for property and equipment | $ 11,289 | $ 16,410 | $ 24,508 | $ 36,004

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- Definition The cash outflow associated with the acquisition of long-lived, physical assets that are used in the normal conduct of business to produce goods and services and not intended for resale; includes cash outflows to pay for construction of self-constructed assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=66902209&loc=d3e3213-108585 + Details
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