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Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | 12 Months Ended |
--- | --- | --- | --- | ---
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | Dec. 31, 2017 | Sep. 30, 2018
Goodwill [Roll Forward] |  |  |  |  |  |
Beginning balance |  |  | $ 6,610,279 | $ 6,015,375 | $ 6,015,375 |
Acquisitions |  |  | 135,654 |  | 617,032 |
Divestitures |  |  | (15,497) |  | (32,386) |
Goodwill impairment charges | $ 0 | $ 0 | (3,106) | (34,696) | (36,196) |
Foreign currency and other adjustments |  |  | (24,671) |  | 46,454 |
Ending balance | 6,702,659 |  | 6,702,659 |  | 6,610,279 |
Goodwill |  |  |  |  |  | $ 6,730,260
Accumulated impairment charges |  |  |  |  |  | (27,601)
Total goodwill by reportable segments | 6,702,659 |  | 6,610,279 | 6,015,375 | 6,015,375 | 6,702,659
U.S. dialysis and related lab services |  |  |  |  |  |
Goodwill [Roll Forward] |  |  |  |  |  |
Beginning balance |  |  | 6,144,761 | 5,691,587 | 5,691,587 |
Acquisitions |  |  | 24,431 |  | 485,434 |
Divestitures |  |  | (331) |  | (32,260) |
Goodwill impairment charges |  |  | 0 |  | 0 |
Foreign currency and other adjustments |  |  | 0 |  | 0 |
Ending balance | 6,168,861 |  | 6,168,861 |  | 6,144,761 |
Goodwill |  |  |  |  |  | 6,168,861
Accumulated impairment charges |  |  |  |  |  | 0
Total goodwill by reportable segments | 6,168,861 |  | 6,144,761 | 5,691,587 | 5,691,587 | 6,168,861
Other—Ancillary services and strategic initiatives |  |  |  |  |  |
Goodwill [Roll Forward] |  |  |  |  |  |
Beginning balance |  |  | 465,518 | 323,788 | 323,788 |
Acquisitions |  |  | 111,223 |  | 131,598 |
Divestitures |  |  | (15,166) |  | (126) |
Goodwill impairment charges |  |  | (3,106) |  | (36,196) |
Foreign currency and other adjustments |  |  | (24,671) |  | 46,454 |
Ending balance | 533,798 |  | 533,798 |  | 465,518 |
Goodwill |  |  |  |  |  | 561,399
Accumulated impairment charges |  |  |  |  |  | (27,601)
Total goodwill by reportable segments | $ 533,798 |  | $ 465,518 | $ 323,788 | $ 323,788 | $ 533,798

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