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Goodwill (Tables) | 9 Months Ended
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Sep. 30, 2018
Goodwill and Intangible Assets Disclosure [Abstract] |
Changes in Goodwill by Reportable Segments | Changes in goodwill by reportable segment were as follows:
| U.S. dialysis and related lab services |  | Other-ancillary services and strategic initiatives |  | Consolidated total
Balance at January 1, 2017 | $ | 5,691,587 |  |  | $ | 323,788 |  |  | $ | 6,015,375 |
Acquisitions | 485,434 |  |  | 131,598 |  |  | 617,032 |
Divestitures | (32,260 | ) |  | (126 | ) |  | (32,386 | )
Impairment charges | — |  |  | (36,196 | ) |  | (36,196 | )
Foreign currency and other adjustments | — |  |  | 46,454 |  |  | 46,454 |
Balance at December 31, 2017 | $ | 6,144,761 |  |  | $ | 465,518 |  |  | $ | 6,610,279 |
Acquisitions | 24,431 |  |  | 111,223 |  |  | 135,654 |
Divestitures | (331 | ) |  | (15,166 | ) |  | (15,497 | )
Impairment charges | — |  |  | (3,106 | ) |  | (3,106 | )
Foreign currency and other adjustments | — |  |  | (24,671 | ) |  | (24,671 | )
Balance at September 30, 2018 | $ | 6,168,861 |  |  | $ | 533,798 |  |  | $ | 6,702,659 |
Balance at September 30, 2018: |  |  |  |  |
Goodwill | $ | 6,168,861 |  |  | $ | 561,399 |  |  | $ | 6,730,260 |
Accumulated impairment charges | — |  |  | (27,601 | ) |  | (27,601 | )
| $ | 6,168,861 |  |  | $ | 533,798 |  |  | $ | 6,702,659 |

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- Definition Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13816-109267 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 2 -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13854-109267 + Details
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