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Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 240,889	$ 216,616	$ 639,829	$ 575,243
U.S. dialysis and related lab services
Segment Reporting Information [Line Items]
Expenditures for property and equipment	205,266	182,741	531,027	467,121
DMG
Segment Reporting Information [Line Items]
Expenditures for property and equipment	24,282	17,396	72,953	55,639
Ancillary services and strategic initiatives
Segment Reporting Information [Line Items]
Expenditures for property and equipment	$ 11,341	$ 16,479	$ 35,849	$ 52,483

X

- 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

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X

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

No definition available.

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