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Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues $ 2,591,074,000 $ 2,422,786,000
Other revenues 232,825,000 315,523,000
Health Care Organization, Revenue 2,849,444,000 2,631,251,000
Intersegment Elimination    
Disaggregation of Revenue [Line Items]    
Other revenues (28,621,000) (18,168,000)
Health Care Organization, Revenue (28,621,000) (18,168,000)
Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 1,485,192,000 1,272,595,000
Other revenues 142,758,000 225,203,000
Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 157,496,000 144,585,000
Other revenues 15,791,000 18,595,000
Other Government Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 189,656,000 139,754,000
Commercial Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 802,697,000 770,593,000
Other revenues 40,420,000 25,207,000
Other    
Disaggregation of Revenue [Line Items]    
Other revenues 44,055,000 52,887,000
U.S. dialysis and related lab services    
Disaggregation of Revenue [Line Items]    
Health Care Organization, Revenue 2,519,478,000 2,259,395,000
U.S. dialysis and related lab services | Intersegment Elimination    
Disaggregation of Revenue [Line Items]    
Other revenues (18,422,000) (11,799,000)
U.S. dialysis and related lab services | Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 1,485,192,000 1,272,595,000
Other revenues 0 0
U.S. dialysis and related lab services | Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 157,496,000 144,585,000
Other revenues 0 0
U.S. dialysis and related lab services | Other Government Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 107,119,000 91,993,000
U.S. dialysis and related lab services | Commercial Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 782,979,000 756,710,000
Other revenues 0 0
U.S. dialysis and related lab services | Other    
Disaggregation of Revenue [Line Items]    
Other revenues 5,114,000 5,311,000
Other—Ancillary services and strategic initiatives    
Disaggregation of Revenue [Line Items]    
Health Care Organization, Revenue 329,966,000 371,856,000
Other—Ancillary services and strategic initiatives | Intersegment Elimination    
Disaggregation of Revenue [Line Items]    
Other revenues (10,199,000) (6,369,000)
Other—Ancillary services and strategic initiatives | Medicare and Medicare Advantage    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 0 0
Other revenues 142,758,000 225,203,000
Other—Ancillary services and strategic initiatives | Medicaid and Managed Medicaid    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 0 0
Other revenues 15,791,000 18,595,000
Other—Ancillary services and strategic initiatives | Other Government Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 82,537,000 47,761,000
Other—Ancillary services and strategic initiatives | Commercial Payors    
Disaggregation of Revenue [Line Items]    
Dialysis and related lab patient service revenues 19,718,000 13,883,000
Other revenues 40,420,000 25,207,000
Other—Ancillary services and strategic initiatives | Other    
Disaggregation of Revenue [Line Items]    
Other revenues $ 38,941,000 $ 47,576,000