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Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended |
--- | --- | ---
Mar. 31, 2019 | Dec. 31, 2018
Debt Instrument [Line Items] |  |
Weighted average effective interest rate at quarter end | 5.14% |
Weighted average effective interest rate during quarter | 5.16% |
Percentage of debt instruments bearing fixed interest rate | 46.31% |
U.S. dialysis and related lab services |  |
Debt Instrument [Line Items] |  |
Letters of credit outstanding | $ 40,871 |
DMG |  |
Debt Instrument [Line Items] |  |
Letters of credit outstanding | 211 |
Revolving Credit Facility |  |
Debt Instrument [Line Items] |  |
Proceeds from Long-term Lines of Credit | 575,000 |
Undrawn revolving credit facilities | 1,000,000 |
Letter of Credit |  |
Debt Instrument [Line Items] |  |
Letters of credit outstanding | $ 38,017 |
Senior Secured Credit Facilities |  |
Debt Instrument [Line Items] |  |
Weighted average effective interest rate at quarter end | 5.00% |
Term Loan A |  |
Debt Instrument [Line Items] |  |
Mandatory principal payments | $ 25,000 |
Secured Debt | 650,000 | $ 675,000
Term Loan B |  |
Debt Instrument [Line Items] |  |
Mandatory principal payments | 8,750 |
Secured Debt | 3,333,750 | $ 3,342,500
Term Loan A subject to uncapped portion of variability of LIBOR |  |
Debt Instrument [Line Items] |  |
Secured Debt | 483,750 |
Maximum |  |
Debt Instrument [Line Items] |  |
Unrestricted Proceeds From Divestiture Of Business | $ 750,000 |

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