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Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($)
 3 Months Ended 9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Sep. 30, 2017
Sep. 30, 2016
Segment Reporting Information [Line Items]        
Patient services revenues $ 2,746,257,000 $ 2,643,194,000 $ 8,030,102,000 $ 7,708,641,000
Less: Provision for uncollectible accounts (123,760,000) (115,555,000) (352,228,000) (336,188,000)
Net dialysis and related lab services patient service revenues 2,622,497,000 2,527,639,000 7,677,874,000 7,372,453,000
Other revenues 283,969,000 330,399,000 863,238,000 996,378,000
Capitated revenues 1,016,365,000 872,538,000 2,956,479,000 2,660,532,000
Total net revenues 3,922,831,000 3,730,576,000 11,497,591,000 11,029,363,000
Operating income (loss) (192,523,000) 819,156,000 1,074,029,000 1,513,115,000
Corporate administrative support (10,965,000) (28,028,000) (32,587,000) (40,366,000)
Debt expense (109,623,000) (104,581,000) (322,014,000) (310,359,000)
Other income, net 4,370,000 1,876,000 13,866,000 8,067,000
(Loss) income before income taxes (297,776,000) 716,451,000 765,881,000 1,210,823,000
Operating Segments        
Segment Reporting Information [Line Items]        
Total net revenues 3,962,985,000 3,763,333,000 11,614,261,000 11,117,560,000
Operating income (loss) (181,558,000) 847,184,000 1,106,616,000 1,553,481,000
Operating Segments | U.S. dialysis and related lab services        
Segment Reporting Information [Line Items]        
Patient services revenues 2,483,644,000 2,428,858,000 7,285,962,000 7,123,873,000
Less: Provision for uncollectible accounts (117,973,000) (109,299,000) (334,078,000) (320,565,000)
Net dialysis and related lab services patient service revenues 2,365,671,000 2,319,559,000 6,951,884,000 6,803,308,000
Other revenues 4,803,000 3,912,000 14,998,000 12,134,000
Total net revenues 2,370,474,000 2,323,471,000 6,966,882,000 6,815,442,000
Operating income (loss) 442,777,000 452,187,000 1,837,989,000 1,341,432,000
Operating Segments | U.S. dialysis and related lab services | External Sources        
Segment Reporting Information [Line Items]        
Patient services revenues 2,457,302,000 2,412,818,000 7,209,424,000 7,079,054,000
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Patient services revenues 26,342,000 16,040,000 76,538,000 44,819,000
Operating Segments | DMG        
Segment Reporting Information [Line Items]        
Net dialysis and related lab services patient service revenues 187,678,000 166,622,000 556,179,000 448,222,000
Other revenues 15,170,000 15,195,000 52,509,000 41,766,000
Capitated revenues 975,526,000 846,245,000 2,852,631,000 2,586,383,000
Total net revenues 1,178,443,000 1,028,137,000 3,461,493,000 3,076,560,000
Operating income (loss) (587,817,000) 33,094,000 (588,389,000) (126,110,000)
Operating Segments | DMG | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Other revenues 69,000 75,000 174,000 189,000
Operating Segments | Ancillary services and strategic initiatives        
Segment Reporting Information [Line Items]        
Net dialysis and related lab services patient service revenues 95,490,000 57,498,000 246,349,000 165,742,000
Other revenues 263,996,000 311,292,000 795,731,000 942,478,000
Capitated revenues 40,839,000 26,293,000 103,848,000 74,149,000
Total net revenues 414,068,000 411,725,000 1,185,886,000 1,225,558,000
Operating income (loss) (36,518,000) 361,903,000 (142,984,000) 338,159,000
Operating Segments | Ancillary services and strategic initiatives | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Total net segment revenues 13,743,000 16,642,000 39,958,000 43,189,000
Intersegment Elimination        
Segment Reporting Information [Line Items]        
Total net revenues $ (40,154,000) (32,757,000) $ (116,670,000) $ (88,197,000)
DMG        
Segment Reporting Information [Line Items]        
Corporate administrative support   $ (27,040,000)