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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands | Mar. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
--- | --- | --- | ---
Business Acquisition [Line Items] |  |  |
Goodwill | $ 6,799,368 | $ 6,841,960 | $ 6,610,279
Dialysis and other businesses |  |  |
Business Acquisition [Line Items] |  |  |
Current assets | 1,117 |  |
Property and equipment | 923 |  |
Intangible and other long-term assets | 4,312 |  |
Goodwill | 8,655 |  |
Current liabilities | (592) |  |
Long-term liabilities | (88) |  |
Noncontrolling interests | (1,762) |  |
Aggregate purchase price | $ 12,565 |  |

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