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Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Goodwill [Roll Forward] |  |  |
Beginning balance | $ 6,610,279 | $ 6,015,375 |
Acquisitions | 278,348 | 617,032 |
Divestitures | (15,497) | (32,386) |
Impairment charges | (3,106) | (36,196) | $ (28,415)
Foreign currency and other adjustments | (28,064) | 46,454 |
Ending balance | 6,841,960 | 6,610,279 | 6,015,375
Goodwill | 6,869,233 |  |
Accumulated impairment charges | (27,273) |  |
U.S. dialysis and related lab services |  |  |
Goodwill [Roll Forward] |  |  |
Beginning balance | 6,144,761 | 5,691,587 |
Acquisitions | 130,574 | 485,434 |
Divestitures | (331) | (32,260) |
Impairment charges | 0 | 0 |
Foreign currency and other adjustments | 0 | 0 |
Ending balance | 6,275,004 | 6,144,761 | 5,691,587
Goodwill | 6,275,004 |  |
Accumulated impairment charges | 0 |  |
Other ancillary services and strategic initiatives |  |  |
Goodwill [Roll Forward] |  |  |
Beginning balance | 465,518 | 323,788 |
Acquisitions | 147,774 | 131,598 |
Divestitures | (15,166) | (126) |
Impairment charges | (3,106) | (36,196) |
Foreign currency and other adjustments | (28,064) | 46,454 |
Ending balance | 566,956 | $ 465,518 | $ 323,788
Goodwill | 594,229 |  |
Accumulated impairment charges | $ (27,273) |  |

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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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- Definition Amount of increase in asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from a business combination. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13816-109267 + Details
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- Definition Amount before 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://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13816-109267 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -SubTopic 20 -Section 50 -Paragraph 1 -Subparagraph (h) -URI http://asc.fasb.org/extlink&oid=108376223&loc=d3e13816-109267 + Details
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