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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Mar. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Business Acquisition [Line Items]      
Goodwill $ 6,638,592 $ 6,610,279 $ 6,015,375
Dialysis and other businesses      
Business Acquisition [Line Items]      
Current assets 1,572    
Property and equipment 1,643    
Amortizable intangible and other long-term assets 2,563    
Goodwill 16,042    
Current liabilities (2,392)    
Noncontrolling interests (688)    
Aggregate purchase price $ 18,740