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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
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Mar. 31, 2019 | Mar. 31, 2018
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | $ 2,635,152 | $ 2,591,074
Provision for uncollectible accounts | (5,463) | 25,545
Net U.S. dialysis and related lab services patient service revenues | 2,629,689 | 2,616,619
Other revenues | 113,423 | 232,825
Total revenues | 2,743,112 | 2,849,444
Operating income (loss) | 340,507 | 410,686
Corporate administrative support | (18,844) | (15,704)
Debt expense | (131,519) | (113,516)
Other income, net | 6,940 | 4,582
Income from continuing operations before income taxes | 215,928 | 301,752
U.S. dialysis and related lab services |  |
Segment Reporting Information [Line Items] |  |
Total revenues | 2,516,510 | 2,519,478
Other—Ancillary services and strategic initiatives |  |
Segment Reporting Information [Line Items] |  |
Total revenues | 226,602 | 329,966
Operating Segments |  |
Segment Reporting Information [Line Items] |  |
Total revenues | 2,777,089 | 2,878,065
Operating income (loss) | 359,351 | 426,390
Operating Segments | U.S. dialysis and related lab services |  |
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | 2,547,709 | 2,507,587
Provision for uncollectible accounts | (5,463) | 25,199
Net U.S. dialysis and related lab services patient service revenues | 2,542,246 | 2,532,786
Total revenues | 2,547,151 | 2,537,900
Operating income (loss) | 416,981 | 433,380
Operating Segments | U.S. dialysis and related lab services | External Sources |  |
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | 2,517,289 | 2,489,165
Other revenues | 4,684 | 5,114
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations |  |
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | 30,420 | 18,422
Other revenues | 221 | 0
Operating Segments | Other—Ancillary services and strategic initiatives |  |
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | 117,863 | 102,255
Other revenues | 108,739 | 227,711
Total revenues | 229,938 | 340,165
Operating income (loss) | (57,630) | (6,990)
Operating Segments | Other—Ancillary services and strategic initiatives | Intersubsegment Eliminations |  |
Segment Reporting Information [Line Items] |  |
Dialysis and related lab patient service revenues | 3,336 | 10,199
Intersegment Elimination |  |
Segment Reporting Information [Line Items] |  |
Total revenues | (33,977) | (28,621)
Intersegment Elimination | U.S. dialysis and related lab services |  |
Segment Reporting Information [Line Items] |  |
Total revenues | (30,641) | (18,422)
Intersegment Elimination | Other—Ancillary services and strategic initiatives |  |
Segment Reporting Information [Line Items] |  |
Total revenues | $ (3,336) | $ (10,199)

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