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Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($)
$ in Thousands
 3 Months Ended 12 Months Ended
Dec. 31, 2017
Sep. 30, 2017
Jun. 30, 2017
Mar. 31, 2017
Dec. 31, 2016
Sep. 30, 2016
Jun. 30, 2016
Mar. 31, 2016
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Segment Reporting Information [Line Items]                      
Dialysis and related lab patient service revenues                 $ 10,093,670 $ 9,727,360 $ 9,155,447
Less: Provision for uncollectible accounts                 (485,398) (431,308) (412,905)
Net U.S. dialysis and related lab services patient service revenues                 9,608,272 9,296,052 8,742,542
Other revenues                 1,268,362 1,411,415 1,239,703
Total net revenues $ 2,780,913 $ 2,765,071 $ 2,699,399 $ 2,631,251 $ 2,699,419 $ 2,725,407 $ 2,675,474 $ 2,607,167 10,876,634 10,707,467 9,982,245
Operating income 150,337 395,294 391,196 875,928 363,445 813,103 431,129 422,033 1,812,755 2,029,710 1,136,766
Corporate administrative support                 (44,966) (13,628) (18,965)
Debt expense                 (430,634) (414,116) (408,380)
Debt redemption charges                 0 0 (48,072)
Other income                 17,665 7,511 8,073
Income from continuing operations before income taxes $ 46,825 $ 289,384 $ 288,060 $ 775,517 $ 259,669 $ 710,246 $ 331,231 $ 321,959 1,399,786 1,623,105 688,387
Operating Segments                      
Segment Reporting Information [Line Items]                      
Total net revenues                 10,956,412 10,759,561 10,023,863
Operating income                 1,857,721 2,043,338 1,155,731
Operating Segments | U.S. dialysis and related lab services                      
Segment Reporting Information [Line Items]                      
Dialysis and related lab patient service revenues                 9,822,298 9,551,422 9,033,991
Less: Provision for uncollectible accounts                 (482,007) (429,882) (406,530)
Net U.S. dialysis and related lab services patient service revenues                 9,340,291 9,121,540 8,627,461
Other revenues                 19,774 16,649 13,971
Total net revenues                 9,360,065 9,138,189 8,641,432
Operating income                 2,297,198 1,777,014 1,259,632
Operating Segments | U.S. dialysis and related lab services | External Sources                      
Segment Reporting Information [Line Items]                      
Dialysis and related lab patient service revenues                 9,767,123 9,524,067 9,014,577
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations                      
Segment Reporting Information [Line Items]                      
Dialysis and related lab patient service revenues                 55,175 27,355 19,414
Operating Segments | Other-Ancillary services and strategic initiatives                      
Segment Reporting Information [Line Items]                      
Net U.S. dialysis and related lab services patient service revenues                 323,156 201,867 134,496
Other revenues                 1,248,588 1,394,766 1,225,731
Intersegment revenues                 24,603 24,739 22,204
Total net revenues                 1,596,347 1,621,372 1,382,431
Operating income                 (439,477) 266,324 (103,901)
Intersegment Elimination                      
Segment Reporting Information [Line Items]                      
Total net revenues                 $ (79,778) $ (52,094) $ (41,618)