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Goodwill - Narrative (Details) - 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 | Dec. 31, 2016
Goodwill [Line Items] |  |  |  |  |  |
Goodwill impairment charges | $ 0 | $ 0 | $ 3,106 | $ 34,696 | $ 36,196 |
Goodwill | 6,702,659 |  | 6,702,659 |  | $ 6,610,279 | $ 6,015,375
Vascular Access Clinic |  |  |  |  |  |
Goodwill [Line Items] |  |  |  |  |  |
Goodwill impairment charges |  |  |  | $ 34,696 |  |
Goodwill | $ 0 |  | 0 |  |  |
GERMANY |  |  |  |  |  |
Goodwill [Line Items] |  |  |  |  |  |
Goodwill impairment charges |  |  | $ 3,106 |  |  |

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- Definition Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 45 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=77989000&loc=SL49117168-202975 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 45 -Paragraph 1 -URI http://asc.fasb.org/extlink&oid=99380562&loc=d3e13770-109266 + Details
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