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Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	Mar. 29, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Unrealized (losses) gains on interest rate cap agreements		$ (268)	$ (1,815)	$ 782	$ (5,002)
Weighted average effective interest rate on senior secured credit facilities		4.99%		4.99%
Weighted average effective interest rate during quarter		4.91%
Fixed interest rate		48.82%		48.82%
U.S. dialysis and related lab services
Debt Instrument [Line Items]
Letters of credit outstanding		$ 22,351		$ 22,351
DMG
Debt Instrument [Line Items]
Letters of credit outstanding		211		211
Revolving Credit Facility
Debt Instrument [Line Items]
Undrawn revolving credit facilities		1,000,000		1,000,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding		14,355		14,355
Interest Rate Cap Agreements Effective September 30, 2016
Debt Instrument [Line Items]
Notional amounts of interest rate agreements		3,500,000		$ 3,500,000
Derivative, effective date				Sep. 30, 2016
Debt expense recognized				$ 4,140
Interest Rate Cap Agreements Effective June 29, 2018
Debt Instrument [Line Items]
Notional amounts of interest rate agreements		3,500,000		$ 3,500,000
Derivative, effective date				Jun. 29, 2018
Derivative, expiration date				Jun. 30, 2020
Fair value of assets		$ 2,085		$ 2,085
Unrealized (losses) gains on interest rate cap agreements				$ 1,053
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective September 30, 2016
Debt Instrument [Line Items]
LIBOR variable rate		3.50%		3.50%
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective June 29, 2018
Debt Instrument [Line Items]
LIBOR variable rate		3.50%		3.50%
Term Loan A-2
Debt Instrument [Line Items]
Line of Credit Facility, Maximum Borrowing Capacity						$ 995,000
Proceeds from Long-term Lines of Credit				$ 952,000
Senior Secured Credit Facilities		$ 952,000		$ 952,000			$ 0
Term Loan A-2 | London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
LIBOR plus interest rate margin				1.00%
Term Loan A
Debt Instrument [Line Items]
Mandatory principal payments		50,000		$ 50,000
Senior Secured Credit Facilities		725,000		$ 725,000			775,000
Term Loan A | London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
LIBOR plus interest rate margin				2.00%
Term Loan B
Debt Instrument [Line Items]
Mandatory principal payments		17,500		$ 17,500
Senior Secured Credit Facilities		3,360,000		$ 3,360,000			$ 3,377,500
Term Loan B | London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
LIBOR plus interest rate margin				2.75%
Term Loan A subject to interest rate caps
Debt Instrument [Line Items]
Senior Secured Credit Facilities		140,000		$ 140,000
Term Loan A subject to uncapped portion of variability of LIBOR
Debt Instrument [Line Items]
Senior Secured Credit Facilities		$ 585,000		$ 585,000
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate on senior secured credit facilities		4.72%		4.72%
Subsequent Event | Term Loan A-2
Debt Instrument [Line Items]
Proceeds from Long-term Lines of Credit	$ 43,000

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