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Acquisitions and divestitures - Additional Information (Detail) $ in Thousands | 3 Months Ended
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Mar. 31, 2019 USD ($) clinic | Mar. 31, 2018 USD ($)
Business Acquisition [Line Items] |  |
Cash paid to acquire businesses | $ 11,274 | $ 16,582
Contingent earn-out obligations and liabilities assumed associated with acquisitions | 11,716 |
Other Accrued Liabilities |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | 650 |
Other long-term liabilities |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | 2,782 |
Other companies |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | $ 3,432 |
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |
Business Acquisition [Line Items] |  |
Earn-out consideration payment period | 1 year |
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |
Business Acquisition [Line Items] |  |
Earn-out consideration payment period | 5 years |
Dialysis and other businesses |  |
Business Acquisition [Line Items] |  |
Cash paid to acquire businesses | $ 10,210 |
Deferred purchase price obligations | 1,457 |
Contingent earn-out obligations and liabilities assumed associated with acquisitions | 898 |
Goodwill deductible for tax purposes associated with acquisitions | $ 6,945 |
Noncompete Agreements |  |
Business Acquisition [Line Items] |  |
Amortizable intangible assets acquired, weighted-average estimated useful lives | 5 years |
U.S. dialysis and related lab services | Dialysis and other businesses |  |
Business Acquisition [Line Items] |  |
Number of businesses acquired | clinic | 2 |
Foreign Dialysis Centers | Dialysis and other businesses |  |
Business Acquisition [Line Items] |  |
Number of businesses acquired | clinic | 2 |

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