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Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($)
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Segment Reporting Information [Line Items]    
Patient services revenues $ 2,591,074,000 $ 2,422,786,000
Provision for uncollectible accounts 25,545,000 (107,058,000)
Net U.S. dialysis and related lab services patient service revenues 2,616,619,000 2,315,728,000
Other revenues 232,825,000 315,523,000
Total revenues 2,849,444,000 2,631,251,000
Operating income (loss) 410,686,000 875,928,000
Corporate administrative support (15,704,000) (10,592,000)
Debt expense (113,516,000) (104,397,000)
Other income, net 4,582,000 3,986,000
Income from continuing operations before income taxes 301,752,000 775,517,000
U.S. dialysis and related lab services    
Segment Reporting Information [Line Items]    
Total revenues 2,519,478,000 2,259,395,000
Other—Ancillary services and strategic initiatives    
Segment Reporting Information [Line Items]    
Total revenues 329,966,000 371,856,000
Operating Segments    
Segment Reporting Information [Line Items]    
Total revenues 2,878,065,000 2,649,419,000
Operating income (loss) 426,390,000 886,520,000
Operating Segments | U.S. dialysis and related lab services    
Segment Reporting Information [Line Items]    
Patient services revenues 2,507,587,000 2,372,660,000
Provision for uncollectible accounts 25,199,000 (106,777,000)
Net U.S. dialysis and related lab services patient service revenues 2,532,786,000 2,265,883,000
Other revenues 5,114,000 5,311,000
Total revenues 2,537,900,000 2,271,194,000
Operating income (loss) 433,380,000 944,740,000
Operating Segments | U.S. dialysis and related lab services | External Sources    
Segment Reporting Information [Line Items]    
Patient services revenues 2,489,165,000 2,360,861,000
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Patient services revenues 18,422,000 11,799,000
Operating Segments | Other—Ancillary services and strategic initiatives    
Segment Reporting Information [Line Items]    
Patient services revenues 102,255,000 61,644,000
Other revenues 227,711,000 310,212,000
Total revenues 340,165,000 378,225,000
Operating income (loss) (6,990,000) (58,220,000)
Operating Segments | Other—Ancillary services and strategic initiatives | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Patient services revenues 10,199,000 6,369,000
Intersegment Elimination    
Segment Reporting Information [Line Items]    
Other revenues (28,621,000) (18,168,000)
Total revenues (28,621,000) (18,168,000)
Intersegment Elimination | U.S. dialysis and related lab services    
Segment Reporting Information [Line Items]    
Other revenues (18,422,000) (11,799,000)
Intersegment Elimination | Other—Ancillary services and strategic initiatives    
Segment Reporting Information [Line Items]    
Other revenues $ (10,199,000) $ (6,369,000)