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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Jun. 30, 2018
Dec. 31, 2017
Dec. 31, 2016
Business Acquisition [Line Items]      
Goodwill $ 6,678,559 $ 6,610,279 $ 6,015,375
Dialysis and other businesses      
Business Acquisition [Line Items]      
Current assets 8,854    
Property and equipment 4,303    
Intangible and other long-term assets 1,486    
Goodwill 106,220    
Current liabilities (10,290)    
Long-term liabilities (171)    
Noncontrolling interests (1,349)    
Aggregate purchase price $ 109,053