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Acquisitions and Divestitures - Additional Information (Details) $ in Thousands |  |  | 3 Months Ended | 12 Months Ended
--- | --- | --- | --- | ---
May 01, 2017 USD ($) patient state clinic outpatient_dialysis_center | Aug. 01, 2016 USD ($) | Dec. 31, 2018 USD ($) | Mar. 31, 2017 USD ($) | Dec. 31, 2018 USD ($) clinic | Dec. 31, 2017 USD ($) clinic | Dec. 31, 2016 USD ($) clinic
Business Acquisition [Line Items] |  |  |  |  |  |  |
Cash paid to acquire business |  |  |  |  | $ 183,156 | $ 803,879 | $ 563,856
Contingent earn-out obligations associated with acquisitions |  |  |  |  | 1,246 |  |
Non-cash gain on acquiring additional ownership in business acquisition |  |  | $ 28,152 |  | 28,152 |  |
Contingent earn-out obligations |  |  | 11,210 |  | 11,210 |  |
Fair value of contingent earn-out consideration |  |  | 2,608 |  | 2,608 | 6,388 |
Other Accrued Liabilities |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | 431 |  | 431 |  |
Other long-term liabilities |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | 2,177 |  | 2,177 |  |
Other companies |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Fair value of contingent earn-out consideration |  |  | 2,608 |  | $ 2,608 |  |
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 |  |
Renal Ventures Limited, LLC |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Cash paid to acquire business | $ 359,913 |  |  |  |  |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  |  |  | 5 years |  |
Goodwill deductible for tax purposes associated with acquisitions |  |  | 298,200 |  | $ 298,200 |  |
Ownership interest percentage | 100.00% |  |  |  |  |  |
Number of dialysis clinic patients | patient | 2,600 |  |  |  |  |  |
Number of states where dialysis centers are located | state | 6 |  |  |  |  |  |
Proceeds from divestiture of business | $ 21,219 |  |  |  |  |  |
Business acquisition, transaction costs |  |  |  |  |  | 11,950 |
Series of individually immaterial business acquisitions |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Cash paid to acquire business |  |  |  |  | 176,161 | 308,550 | 165,108
Contingent earn-out obligations associated with acquisitions |  |  |  |  | 1,246 | 2,692 | 1,511
Liabilities assumed |  |  |  |  | $ 34,394 | $ 23,748 | $ 17,963
Amortizable intangible assets acquired, weighted-average estimated useful lives |  |  |  |  | 6 years | 7 years | 7 years
Goodwill deductible for tax purposes associated with acquisitions |  |  | $ 165,013 |  | $ 165,013 | $ 237,363 | $ 169,379
U S Dialysis And Related Lab Services | Series of individually immaterial business acquisitions |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses acquired | clinic |  |  |  |  | 18 | 30 | 8
Foreign Dialysis Centers | Series of individually immaterial business acquisitions |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses acquired | clinic |  |  |  |  | 28 | 68 | 21
Operating Dialysis Center |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses divested | outpatient_dialysis_center | 3 |  |  |  |  |  |
Operating Dialysis Center | Renal Ventures Limited, LLC |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses acquired | clinic | 36 |  |  |  |  |  |
Number of businesses divested | outpatient_dialysis_center | 3 |  |  |  |  |  |
New Center Under Construction | Renal Ventures Limited, LLC |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses acquired | clinic | 1 |  |  |  |  |  |
Number of businesses divested | outpatient_dialysis_center | 1 |  |  |  |  |  |
Home Dialysis Clinic | Renal Ventures Limited, LLC |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Number of businesses acquired | clinic | 1 |  |  |  |  |  |
Khazanah And Mitsui | Asia-Pacific dialysis business |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |
Non-cash non-taxable gain |  | $ (374,374) |  | $ (6,273) |  |  |

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