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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands | Jun. 30, 2019 | Dec. 31, 2018 | Dec. 31, 2017
--- | --- | --- | ---
Business Acquisition [Line Items] |  |  |
Goodwill | $ 6,865,386 | $ 6,841,960 | $ 6,610,279
Dialysis and other businesses |  |  |
Business Acquisition [Line Items] |  |  |
Current assets | 3,607 |  |
Property and equipment | 2,135 |  |
Intangible and other long-term assets | 8,443 |  |
Goodwill | 66,614 |  |
Current liabilities | (2,067) |  |
Long-term liabilities | (88) |  |
Noncontrolling interests | (1,762) |  |
Aggregate purchase price | $ 76,882 |  |

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