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Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($) $ in Thousands | 12 Months Ended |  |
--- | --- | --- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Goodwill [Line Items] |  |  |
Goodwill | $ 6,841,960 | $ 6,610,279 | $ 6,015,375
Percentage change in operating income used to evaluate fair value of reporting unit for goodwill assessment | 3.00% |  |
Percentage change in discount rate used to evaluate fair value of reporting unit for goodwill assessment | 1.00% |  |
Kidney Care | GERMANY |  |  |
Goodwill [Line Items] |  |  |
Goodwill | $ 403,200 |  |
Carrying amount coverage | 0.50% |  |
Sensitivities, Operating Income | (1.50%) |  |
Sensitivities, Discount rate | (10.30%) |  |
Kidney Care | BRAZIL |  |  |
Goodwill [Line Items] |  |  |
Goodwill | $ 39,452 |  |
Carrying amount coverage | 9.80% |  |
Sensitivities, Operating Income | (2.50%) |  |
Sensitivities, Discount rate | (7.30%) |  |
International Operations | GERMANY |  |  |
Goodwill [Line Items] |  |  |
Goodwill | $ 12,646 |  |
Carrying amount coverage | 8.10% |  |
Sensitivities, Operating Income | (2.20%) |  |
Sensitivities, Discount rate | (11.10%) |  |

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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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