Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Goodwill [Roll Forward]
Beginning balance	$ 6,015,375	$ 5,896,215
Acquisitions	617,032	198,927
Divestitures	(32,386)	(42,536)
Goodwill impairment charges	(36,196)	(28,415)	$ (4,066)
Foreign currency and other adjustments	46,454	(8,816)
Ending balance	6,610,279	6,015,375	5,896,215
Goodwill	6,680,799
Accumulated impairment charges	(70,520)
U.S. dialysis and related lab services
Goodwill [Roll Forward]
Beginning balance	5,691,587	5,629,183
Acquisitions	485,434	75,295
Divestitures	(32,260)	(12,891)
Goodwill impairment charges	0	0
Foreign currency and other adjustments	0	0
Ending balance	6,144,761	5,691,587	5,629,183
Goodwill	6,144,761
Accumulated impairment charges	0
Other ancillary services and strategic initiatives
Goodwill [Roll Forward]
Beginning balance	323,788	267,032
Acquisitions	131,598	123,632
Divestitures	(126)	(29,645)
Goodwill impairment charges	(36,196)	(28,415)
Foreign currency and other adjustments	46,454	(8,816)
Ending balance	465,518	$ 323,788	$ 267,032
Goodwill	536,038
Accumulated impairment charges	$ (70,520)

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

Reference 1: http://www.xbrl.org/2003/role/presentationRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=35741047&loc=d3e13816-109267

Reference 2: http://www.xbrl.org/2003/role/presentationRef
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Amount of increase in asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from a business combination.

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Amount of foreign currency translation gain (loss) which increases (decreases) an asset representing future economic benefits from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount before accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of accumulated impairment loss for an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of loss from the write-down of an asset representing the future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Reference 1: http://www.xbrl.org/2003/role/presentationRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
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-Section 50
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-Publisher FASB
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-URI http://asc.fasb.org/extlink&oid=6388280&loc=d3e13777-109266

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A roll forward is a reconciliation of a concept from the beginning of a period to the end of a period.

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Amount of divestiture of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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