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Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($)
 3 Months Ended 12 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Dec. 31, 2017
Mar. 31, 2018
Goodwill [Roll Forward]        
Beginning balance $ 6,610,279,000 $ 6,015,375,000 $ 6,015,375,000  
Acquisitions 16,042,000   617,032,000  
Divestitures     (32,386,000)  
Goodwill impairment charges 0 (24,198,000) (36,196,000)  
Foreign currency and other adjustments 12,271,000   46,454,000  
Ending balance 6,638,592,000   6,610,279,000  
Goodwill       $ 6,709,112,000
Accumulated impairment charges       (70,520,000)
Total goodwill by reportable segments 6,610,279,000 6,015,375,000 6,015,375,000 6,638,592,000
U.S. dialysis and related lab services        
Goodwill [Roll Forward]        
Beginning balance 6,144,761,000 5,691,587,000 5,691,587,000  
Acquisitions 2,137,000   485,434,000  
Divestitures     (32,260,000)  
Goodwill impairment charges     0  
Foreign currency and other adjustments 0   0  
Ending balance 6,146,898,000   6,144,761,000  
Goodwill       6,146,898,000
Accumulated impairment charges       0
Total goodwill by reportable segments 6,144,761,000 5,691,587,000 5,691,587,000 6,146,898,000
Other—Ancillary services and strategic initiatives        
Goodwill [Roll Forward]        
Beginning balance 465,518,000 323,788,000 323,788,000  
Acquisitions 13,905,000   131,598,000  
Divestitures     (126,000)  
Goodwill impairment charges     (36,196,000)  
Foreign currency and other adjustments 12,271,000   46,454,000  
Ending balance 491,694,000   465,518,000  
Goodwill       562,214,000
Accumulated impairment charges       (70,520,000)
Total goodwill by reportable segments $ 465,518,000 $ 323,788,000 $ 323,788,000 $ 491,694,000