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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Sep. 30, 2017
May 01, 2017
Dec. 31, 2016
Dec. 31, 2015
Business Acquisition [Line Items]        
Goodwill $ 9,415,877   $ 9,407,317 $ 9,294,479
Renal Ventures        
Business Acquisition [Line Items]        
Current assets   $ 24,525    
Property and equipment   36,295    
Amortizable intangible and other long-term assets   11,547    
Goodwill   298,358    
Current liabilities   (8,684)    
Long-term liabilities   (478)    
Aggregate purchase price   $ 361,563    
Dialysis and other businesses        
Business Acquisition [Line Items]        
Current assets 11,548      
Property and equipment 28,384      
Amortizable intangible and other long-term assets 18,403      
Non-amortizable intangibles 31,983      
Goodwill 389,517      
Current liabilities (20,628)      
Long-term liabilities (8,223)      
Noncontrolling interests (36,075)      
Aggregate purchase price $ 414,909