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Organization and Summary of Significant Accounting Policies - Additional Information (Details) $ in Thousands |  | 12 Months Ended |  |
--- | --- | --- | --- | ---
Jan. 01, 2019 USD ($) | Dec. 31, 2019 patient state country clinic entity | Dec. 31, 2018 USD ($) | Dec. 31, 2017 USD ($)
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Number of legal entities that third parties held noncontrolling equity interests | entity |  | 672 |  |
Minimum |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Lessee, Operating Lease, Term of Contract |  | 5 years |  |
Lessee, Operating Lease, Renewal Term |  | 5 years |  |
Minimum | Noncompetition agreements |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Amortization period |  | 3 years |  |
Minimum | Buildings |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Property, and equipment useful lives |  | 25 years |  |
Minimum | Leasehold Improvements |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Property, and equipment useful lives |  | 10 years |  |
Minimum | Equipment and Information Systems |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Property, and equipment useful lives |  | 3 years |  |
Maximum |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Lessee, Operating Lease, Term of Contract |  | 15 years |  |
Lessee, Operating Lease, Renewal Term |  | 10 years |  |
Maximum | Noncompetition agreements |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Amortization period |  | 10 years |  |
Maximum | Buildings |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Property, and equipment useful lives |  | 40 years |  |
Maximum | Equipment and Information Systems |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Property, and equipment useful lives |  | 15 years |  |
Accounting Standards Update 2016-02 | Lease Assets |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification | $ 2,783,784 |  |  |
Accounting Standards Update 2016-02 | Lease Liabilities |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification | 3,001,354 |  |  |
Retained earnings |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Cumulative Effect of New Accounting Principle in Period of Adoption |  |  | $ 39,876 | $ 8,368
Cash Flow Effect | Accounting Standards Update 2016-02 |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification | $ 0 |  |  |
United States |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Number of dialysis centers that the company operated or provided administrative services | clinic |  | 2,753 |  |
Number of states where dialysis centers are located | state |  | 46 |  |
Number of patients served | patient |  | 206,900 |  |
International Operations |  |  |  |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] |  |  |  |
Number of dialysis centers that the company operated or provided administrative services | clinic |  | 259 |  |
Number of patients served | patient |  | 28,700 |  |
Number of countries in which dialysis centers located | country |  | 10 |  |

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