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Goodwill - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Line Items]
Goodwill impairment charges	$ 3,106	$ 10,498	$ 3,106	$ 34,696	$ 36,196
Goodwill	$ 6,678,559		6,678,559		$ 6,610,279	$ 6,015,375
Percentage Change In Operating Income Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment	3.00%
Percentage Change In Discount Rate Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment	1.00%
Vascular Access Clinic
Goodwill [Line Items]
Goodwill impairment charges		$ 10,498		$ 34,696
Goodwill	$ 0		0
GERMANY
Goodwill [Line Items]
Goodwill impairment charges	3,106
BRAZIL
Goodwill [Line Items]
Goodwill	$ 54,940		$ 54,940
Carrying amount coverage	9.80%		9.80%
Sensitivities, operating income	(2.50%)		(2.50%)
Sensitivities, discount rate	(7.30%)

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