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Acquisitions and divestitures - Additional Information (Detail) $ in Thousands |  | 3 Months Ended | 9 Months Ended |
--- | --- | --- | --- | ---
Jun. 01, 2018 | Sep. 30, 2018 USD ($) | Sep. 30, 2017 USD ($) | Sep. 30, 2018 USD ($) Clinic | Sep. 30, 2017 USD ($) | Dec. 31, 2017 USD ($)
Business Acquisition [Line Items] |  |  |  |  |  |
Cash paid to acquire businesses |  |  |  | $ 113,526 | $ 726,538 |
Contingent earn-out obligations and liabilities assumed associated with acquisitions |  |  |  | 14,042 |  |
Gain (Loss) on Disposition of Business |  | $ (1,506) | $ 0 | 32,451 | $ 6,273 |
Contingent earn-out obligations |  | 7,233 |  | 7,233 |  | $ 6,388
Other Accrued Liabilities |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Contingent earn-out obligations |  | 431 |  | 431 |  |
Other long-term liabilities |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Contingent earn-out obligations |  | 6,802 |  | 6,802 |  |
Other companies |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Contingent earn-out obligations |  | 7,233 |  | $ 7,233 |  |
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Earn-out consideration payment period |  |  |  | 1 year |  |
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Earn-out consideration payment period |  |  |  | 5 years |  |
Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Cash paid to acquire businesses |  |  |  | $ 110,671 |  |
Deferred purchase price obligations |  |  |  | 15,461 |  |
Contingent earn-out obligations and liabilities assumed associated with acquisitions |  |  |  | 4,733 |  |
Goodwill deductible for tax purposes associated with acquisitions |  | $ 115,378 |  | $ 115,378 |  |
Noncompete Agreements |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  |  | 5 years |  |
U.S. dialysis and related lab services | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  |  |  | 5 |  |
Foreign Dialysis Centers | Dialysis and other businesses |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Number of businesses acquired | Clinic |  |  |  | 18 |  |
Paladina |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Sale of Stock, Percentage of Ownership before Transaction | 100.00% |  |  |  |  |
Gain (Loss) on Disposition of Business |  |  |  | $ 33,699 |  |

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