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Goodwill Goodwill - Schedule of Reporting Units Goodwill Balances (Details) (Details) - USD ($) $ in Thousands | 3 Months Ended |  |
--- | --- | --- | ---
Mar. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Goodwill [Line Items] |  |  |
Goodwill | $ 6,799,368 | $ 6,841,960 | $ 6,610,279
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% |  |
GERMANY | Kidney Care |  |  |
Goodwill [Line Items] |  |  |
Goodwill | $ 354,182 |  |
Reporting Unit Percentage Of Fair Value In Excess Of Short Of Carrying Amount | 0.00% |  |
Potential Impact On Fair Value For Reduction In Operating Income | (1.40%) |  |
Potential Impact On Fair Value For Basis Point Increase In Discount Rate | (9.30%) |  |

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