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Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended |  |
--- | --- | --- | --- | ---
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | Mar. 29, 2018 | Dec. 31, 2017
Debt Instrument [Line Items] |  |  |  |  |  |
Gain (loss) on interest rate cap agreements due to change in their unrealized fair value | $ 37 | $ (478) | $ 819 | $ (5,479) |  |
Weighted average effective interest rate at quarter end | 5.03% |  | 5.03% |  |  |
Weighted average effective interest rate during quarter | 4.93% |  | 4.92% |  |  |
Percentage of debt instruments bearing fixed interest rate | 47.43% |  | 47.43% |  |  |
U.S. dialysis and related lab services |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Letters of credit outstanding | $ 22,621 |  | $ 22,621 |  |  |
DMG |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Letters of credit outstanding | 211 |  | 211 |  |  |
Revolving Credit Facility |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Proceeds from Long-term Lines of Credit | 275,000 |  |  |  |  |
Undrawn revolving credit facilities | 1,000,000 |  | 1,000,000 |  |  |
Letter of Credit |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Letters of credit outstanding | 14,355 |  | 14,355 |  |  |
Interest Rate Cap Agreements Effective September 30, 2016 |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Notional amounts of interest rate agreements | 3,500,000 |  | $ 3,500,000 |  |  |
Derivative, expiration date |  |  | Jun. 30, 2018 |  |  |
Debt expense recognized |  |  | $ 4,140 |  |  |
Interest Rate Cap Agreements Effective June 29, 2018 |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Notional amounts of interest rate agreements | 3,500,000 |  | $ 3,500,000 |  |  |
Derivative, effective date |  |  | Jun. 29, 2018 |  |  |
Derivative, expiration date |  |  | Jun. 30, 2020 |  |  |
Fair value of assets | $ 2,135 |  | $ 2,135 |  |  |
Debt expense recognized |  |  | 2,163 |  |  |
Gain (loss) on interest rate cap agreements due to change in their unrealized fair value |  |  | $ 1,103 |  |  |
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective September 30, 2016 |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
LIBOR variable rate | 3.50% |  | 3.50% |  |  |
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective June 29, 2018 |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
LIBOR variable rate | 3.50% |  | 3.50% |  |  |
Term Loan A-2 |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Credit Facility, Maximum Borrowing Capacity |  |  |  |  | $ 995,000 |
Secured Debt | $ 995,000 |  | $ 995,000 |  |  | $ 0
Term Loan A-2 | London Interbank Offered Rate (LIBOR) |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
LIBOR plus interest rate margin |  |  | 1.00% |  |  |
Term Loan A |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Mandatory principal payments | 75,000 |  | $ 75,000 |  |  |
Secured Debt | 700,000 |  | $ 700,000 |  |  | 775,000
Term Loan A | London Interbank Offered Rate (LIBOR) |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
LIBOR plus interest rate margin |  |  | 2.00% |  |  |
Term Loan B |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Mandatory principal payments | 26,250 |  | $ 26,250 |  |  |
Secured Debt | 3,351,250 |  | $ 3,351,250 |  |  | $ 3,377,500
Term Loan B | London Interbank Offered Rate (LIBOR) |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
LIBOR plus interest rate margin |  |  | 2.75% |  |  |
Term Loan A subject to interest rate caps |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Secured Debt | 148,750 |  | $ 148,750 |  |  |
Term Loan A subject to uncapped portion of variability of LIBOR |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Secured Debt | $ 551,250 |  | $ 551,250 |  |  |
Senior Secured Credit Facilities |  |  |  |  |  |
Debt Instrument [Line Items] |  |  |  |  |  |
Weighted average effective interest rate at quarter end | 4.80% |  | 4.80% |  |  |

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