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v3.19.1

Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Mar. 31, 2019 | Mar. 31, 2018 | Dec. 31, 2018
Goodwill [Roll Forward] |  |  |
Beginning balance | $ 6,841,960 | $ 6,610,279 | $ 6,610,279
Acquisitions | 8,655 |  | 278,348
Divestitures |  |  | (15,497)
Impairment charges | (41,037) | 0 | (3,106)
Foreign currency and other adjustments | (10,210) |  | (28,064)
Ending balance | 6,799,368 |  | 6,841,960
Goodwill | 6,867,378 |  |
Accumulated impairment charges | (68,010) |  |
Ending balance | 6,799,368 |  | 6,841,960
U.S. dialysis and related lab services |  |  |
Goodwill [Roll Forward] |  |  |
Beginning balance | 6,275,004 | 6,144,761 | 6,144,761
Acquisitions | 7,027 |  | 130,574
Divestitures |  |  | (331)
Impairment charges | 0 |  | 0
Foreign currency and other adjustments | 0 |  | 0
Ending balance | 6,282,031 |  | 6,275,004
Goodwill | 6,282,031 |  |
Accumulated impairment charges | 0 |  |
Ending balance | 6,282,031 |  | 6,275,004
Other—Ancillary services and strategic initiatives |  |  |
Goodwill [Roll Forward] |  |  |
Beginning balance | 566,956 | $ 465,518 | 465,518
Acquisitions | 1,628 |  | 147,774
Divestitures |  |  | (15,166)
Impairment charges | (41,037) |  | (3,106)
Foreign currency and other adjustments | (10,210) |  | (28,064)
Ending balance | 517,337 |  | 566,956
Goodwill | 585,347 |  |
Accumulated impairment charges | (68,010) |  |
Ending balance | $ 517,337 |  | $ 566,956

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