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Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | $ 2,670,701 | $ 2,561,543 | $ 7,980,178 | $ 7,478,938
Provision for uncollectible accounts | (11,977) | (119,321) | (35,838) | (335,979)
Net U.S. dialysis and related lab services patient service revenues | 2,658,724 | 2,442,222 | 7,944,340 | 7,142,959
Other revenues | 188,606 | 322,849 | 639,387 | 952,762
Total revenues | 2,847,330 | 2,765,071 | 8,583,727 | 8,095,721
Operating income (loss) | 289,038 | 395,294 | 1,137,916 | 1,662,418
Corporate administrative support | (40,836) | (10,965) | (70,605) | (32,587)
Debt expense | (125,927) | (109,306) | (359,135) | (321,637)
Other income, net | 4,007 | 3,396 | 10,583 | 12,180
Income from continuing operations before income taxes | 167,118 | 289,384 | 789,364 | 1,352,961
U.S. dialysis and related lab services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 2,551,377 | 2,356,999 | 7,639,101 | 6,928,323
Other—Ancillary services and strategic initiatives |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 295,953 | 408,072 | 944,626 | 1,167,398
Operating Segments |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 2,881,115 | 2,784,542 | 8,675,418 | 8,152,768
Operating income (loss) | 329,874 | 406,259 | 1,208,521 | 1,695,005
Operating Segments | U.S. dialysis and related lab services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | 2,584,769 | 2,483,644 | 7,725,187 | 7,285,962
Provision for uncollectible accounts | (12,900) | (117,962) | (37,108) | (334,031)
Net U.S. dialysis and related lab services patient service revenues | 2,571,869 | 2,365,682 | 7,688,079 | 6,951,931
Other revenues | 4,932 | 4,792 | 14,965 | 14,951
Total revenues | 2,576,801 | 2,370,474 | 7,703,044 | 6,966,882
Operating income (loss) | 390,006 | 442,777 | 1,272,828 | 1,837,989
Operating Segments | U.S. dialysis and related lab services | External Sources |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | 2,559,345 | 2,470,169 | 7,661,244 | 7,247,403
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | 25,424 | 13,475 | 63,943 | 38,559
Operating Segments | Other—Ancillary services and strategic initiatives |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | 112,279 | 90,015 | 320,204 | 229,587
Other revenues | 183,674 | 318,057 | 624,422 | 937,811
Total revenues | 304,314 | 414,068 | 972,374 | 1,185,886
Operating income (loss) | (60,132) | (36,518) | (64,307) | (142,984)
Operating Segments | Other—Ancillary services and strategic initiatives | Intersubsegment Eliminations |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis and related lab patient service revenues | 8,361 | 5,996 | 27,748 | 18,488
Intersegment Elimination |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | (33,785) | (19,471) | (91,691) | (57,047)
Intersegment Elimination | U.S. dialysis and related lab services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | (25,424) | (13,475) | (63,943) | (38,559)
Intersegment Elimination | Other—Ancillary services and strategic initiatives |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | $ (8,361) | $ (5,996) | $ (27,748) | $ (18,488)

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