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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, 2017
Jun. 30, 2016
Jun. 30, 2017
Jun. 30, 2016
Segment Reporting Information [Line Items]        
Patient service revenues $ 2,682,467 $ 2,583,514 $ 5,283,845 $ 5,065,448
Less: Provision for uncollectible accounts (115,485) (111,428) (228,468) (220,633)
Net dialysis and related lab services patient service revenues 2,566,982 2,472,086 5,055,377 4,844,815
Other revenues 288,417 345,580 579,269 665,979
Total net operating revenues 3,877,477 3,717,651 7,574,760 7,298,787
Capitated revenues 1,022,078 899,985 1,940,114 1,787,993
Operating income (loss) 378,316 329,070 1,266,552 693,959
Corporate administrative support (11,031) (5,417) (21,622) (12,337)
Debt expense (107,962) (102,894) (212,391) (205,778)
Other income, net 5,253 3,215 9,496 6,191
Consolidated income before income taxes 275,607 229,391 1,063,657 494,372
Operating Segments        
Segment Reporting Information [Line Items]        
Total net operating revenues 3,914,873 3,746,885 7,651,277 7,354,227
Operating income (loss) 389,347 334,487 1,288,174 706,296
Operating Segments | U.S. dialysis and related lab services        
Segment Reporting Information [Line Items]        
Patient service revenues 2,429,658 2,367,044 4,802,319 4,695,015
Less: Provision for uncollectible accounts (109,335) (106,515) (216,105) (211,266)
Net dialysis and related lab services patient service revenues 2,320,323 2,260,529 4,586,214 4,483,749
Other revenues [1] 4,891 4,250 10,194 8,223
Total net operating revenues 2,325,214 2,264,779 4,596,408 4,491,972
Operating income (loss) [2] 450,472 449,190 1,395,212 889,245
Operating Segments | U.S. dialysis and related lab services | External Sources        
Segment Reporting Information [Line Items]        
Patient service revenues 2,403,222 2,352,574 4,752,123 4,666,236
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Patient service revenues 26,436 14,470 50,196 28,779
Operating Segments | DMG        
Segment Reporting Information [Line Items]        
Net dialysis and related lab services patient service revenues 189,529 169,167 368,501 281,601
Other revenues [3] 19,070 16,235 37,339 26,569
Total net operating revenues 1,196,066 1,059,565 2,283,050 2,048,423
Capitated revenues 987,420 874,119 1,877,105 1,740,138
Operating income (loss) (12,880) (102,059) (572) (159,204)
Operating Segments | DMG | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Other revenues 47 44 105 115
Operating Segments | Ancillary services and strategic initiatives        
Segment Reporting Information [Line Items]        
Net dialysis and related lab services patient service revenues 83,566 56,860 150,858 108,244
Other revenues 264,456 325,095 531,736 631,187
Total net operating revenues 393,593 422,541 771,819 813,832
Capitated revenues 34,658 25,866 63,009 47,855
Operating income (loss) (48,245) (12,644) (106,466) (23,745)
Operating Segments | Ancillary services and strategic initiatives | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Total net operating revenues 10,913 14,720 26,216 26,546
Intersegment Elimination        
Segment Reporting Information [Line Items]        
Total net operating revenues $ (37,396) $ (29,234) $ (76,517) $ (55,440)
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