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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 6 Months Ended
Jun. 30, 2018
Jun. 30, 2017
Jun. 30, 2018
Jun. 30, 2017
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues $ 2,718,403,000 $ 2,494,609,000 $ 5,309,477,000 $ 4,917,395,000
Provision for uncollectible accounts (49,406,000) (109,600,000) (23,861,000) (216,658,000)
Net U.S. dialysis and related lab services patient service revenues 2,668,997,000 2,385,009,000 5,285,616,000 4,700,737,000
Other revenues 217,956,000 314,390,000 450,781,000 629,913,000
Total revenues 2,886,953,000 2,699,399,000 5,736,397,000 5,330,650,000
Operating income (loss) 438,192,000 391,196,000 848,878,000 1,267,124,000
Corporate administrative support (14,066,000) (11,031,000) (29,769,000) (21,622,000)
Debt expense (119,692,000) (107,934,000) (233,208,000) (212,331,000)
Other income, net 1,994,000 4,798,000 6,576,000 8,784,000
Income from continuing operations before income taxes 320,494,000 288,060,000 622,246,000 1,063,577,000
U.S. dialysis and related lab services        
Segment Reporting Information [Line Items]        
Total revenues 2,568,247,000 2,311,930,000 5,087,724,000 4,571,324,000
Other—Ancillary services and strategic initiatives        
Segment Reporting Information [Line Items]        
Total revenues 318,706,000 387,469,000 648,673,000 759,326,000
Operating Segments        
Segment Reporting Information [Line Items]        
Total revenues 2,916,238,000 2,718,808,000 5,794,303,000 5,368,227,000
Operating income (loss) 452,258,000 402,227,000 878,647,000 1,288,746,000
Operating Segments | U.S. dialysis and related lab services        
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues 2,632,830,000 2,429,658,000 5,140,418,000 4,802,318,000
Provision for uncollectible accounts (49,406,000) (109,292,000) (24,208,000) (216,069,000)
Net U.S. dialysis and related lab services patient service revenues 2,583,424,000 2,320,366,000 5,116,210,000 4,586,249,000
Other revenues 4,919,000 4,849,000 10,033,000 10,159,000
Total revenues 2,588,343,000 2,325,215,000 5,126,243,000 4,596,408,000
Operating income (loss) 449,443,000 450,472,000 882,822,000 1,395,212,000
Operating Segments | U.S. dialysis and related lab services | External Sources        
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues 2,612,734,000 2,416,373,000 5,101,899,000 4,777,234,000
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues 20,096,000 13,285,000 38,519,000 25,084,000
Operating Segments | Other—Ancillary services and strategic initiatives        
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues 105,669,000 77,928,000 207,925,000 139,572,000
Other revenues 213,037,000 309,541,000 440,748,000 619,754,000
Total revenues 327,895,000 393,593,000 668,060,000 771,819,000
Operating income (loss) 2,815,000 (48,245,000) (4,175,000) (106,466,000)
Operating Segments | Other—Ancillary services and strategic initiatives | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Dialysis and related lab patient service revenues 9,189,000 6,124,000 19,387,000 12,493,000
Intersegment Elimination        
Segment Reporting Information [Line Items]        
Other revenues (29,285,000) (19,409,000) (57,906,000) (37,577,000)
Total revenues (29,285,000) (19,409,000) (57,906,000) (37,577,000)
Intersegment Elimination | U.S. dialysis and related lab services        
Segment Reporting Information [Line Items]        
Other revenues (20,096,000) (13,285,000) (38,519,000) (25,084,000)
Intersegment Elimination | Other—Ancillary services and strategic initiatives        
Segment Reporting Information [Line Items]        
Other revenues $ (9,189,000) $ (6,124,000) $ (19,387,000) $ (12,493,000)