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Acquisitions and divestitures - Additional Information (Detail) $ in Thousands |  | 1 Months Ended | 3 Months Ended | 6 Months Ended |
--- | --- | --- | --- | --- | ---
May 01, 2017 USD ($) Clinic Person | Dec. 31, 2012 Clinic | Jun. 30, 2017 USD ($) | Jun. 30, 2017 USD ($) Clinic | Jun. 30, 2016 USD ($) | Dec. 31, 2016 USD ($)
Business Acquisition [Line Items] |  |  |  |  |  |
Cash paid to acquire businesses |  |  |  | $ 619,839 | $ 473,314 |
Contingent earn-out obligations associated with acquisitions |  |  |  | $ 16,684 |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  |  | 5 years |  |
Business Combination, Contingent Consideration, Liability |  |  | $ 11,674 | $ 11,674 |  | $ 9,977
Other Accrued Liabilities |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Business Combination, Contingent Consideration, Liability |  |  | 4,666 | 4,666 |  |
Other long-term liabilities |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Business Combination, Contingent Consideration, Liability |  |  | 7,008 | 7,008 |  |
Other companies |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Business Combination, Contingent Consideration, Liability |  |  | 11,674 | $ 11,674 |  |
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Earn-out consideration payment period |  |  |  | 1 year |  |
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Earn-out consideration payment period |  |  |  | 6 years |  |
Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  | 2 |  |  |  |
Cash paid to acquire businesses |  |  |  | $ 258,276 |  |
Deferred purchase price obligations |  |  |  | 3,823 |  |
Contingent earn-out obligations associated with acquisitions |  |  |  | 8,787 |  |
Goodwill deductible for tax purposes associated with acquisitions |  |  | 207,080 | 207,080 |  |
Renal Ventures |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Business Acquisition, Effective Date of Acquisition | May 01, 2017 |  |  |  |  |
Business Acquisition, Percentage of Voting Interests Acquired | 100.00% |  |  |  |  |
Number Of Dialysis Patients | Person | 2,600 |  |  |  |  |
Number of States in which Entity Operates | 6 |  |  |  |  |
Proceeds from Divestiture of Businesses | $ 21,219 |  |  |  |  |
Business Acquisition, Transaction Costs |  |  | 4,600 | 4,600 |  |
Cash paid to acquire businesses | $ 361,563 |  |  |  |  |
Goodwill deductible for tax purposes associated with acquisitions |  |  | $ 296,582 | $ 296,582 |  |
Noncompete Agreements |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  |  | 5 years |  |
Noncompete Agreements | Renal Ventures |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  | 5 years |  |  |
U.S. dialysis and related lab services | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  |  |  | 20 |  |
Foreign Dialysis Centers | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  |  |  | 55 |  |
Other Medical Businesses | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  |  |  | 5 |  |
Operating Dialysis Center [Member] | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of Businesses Divested | Clinic | 3 |  |  |  |  |
Operating Dialysis Center [Member] | Renal Ventures |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic | 36 |  |  |  |  |
Number of Businesses Divested | Clinic | 3 |  |  |  |  |
New Center Under Construction [Member] | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of Businesses Divested | Clinic | 1 |  |  |  |  |
New Center Under Construction [Member] | Renal Ventures |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic | 1 |  |  |  |  |
Home Dialysis Clinic [Member] | Renal Ventures |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic | 1 |  |  |  |  |

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