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Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Details) - USD ($)
$ in Thousands
 1 Months Ended 12 Months Ended
Jan. 31, 2017
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2010
Epogen          
Commitments And Contingencies Disclosure [Line Items]          
Long term purchase commitment, expiration date Dec. 31, 2022        
Dialysis Equipment, Parts and Supplies          
Commitments And Contingencies Disclosure [Line Items]          
Long term purchase commitment, expiration date   Dec. 31, 2020     Dec. 31, 2013
Purchase commitment, purchase during the period   $ 176,212 $ 164,766 $ 154,566  
Hemodialysis Products, Supplies and Equipment          
Commitments And Contingencies Disclosure [Line Items]          
Long term purchase commitment, expiration date   Dec. 31, 2018      
Purchase commitment, purchase during the period   $ 166,764 $ 162,109 $ 112,931  
Minimum          
Commitments And Contingencies Disclosure [Line Items]          
Scheduled dissolution term of joint ventures   10 years      
Minimum | Epogen          
Commitments And Contingencies Disclosure [Line Items]          
Long-term purchase commitment, percentage of quantity required 90.00%        
Maximum          
Commitments And Contingencies Disclosure [Line Items]          
Scheduled dissolution term of joint ventures   50 years      
Commitments to Provide Operating Capital          
Commitments And Contingencies Disclosure [Line Items]          
Other potential commitments to provide operating capital to several dialysis centers   $ 5,385