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Goodwill (Tables)
 6 Months Ended
Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments [Text Block]
Changes in goodwill by reportable segments were as follows:
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
Balance at December 31, 2018
$
6,275,004

 
$
566,956

 
$
6,841,960

Acquisitions
18,089

 
72,137

 
90,226

Impairment charges
—

 
(124,892
)
 
(124,892
)
Foreign currency and other adjustments
(5,993
)
 
(13,666
)
 
(19,659
)
Balance at December 31, 2019
$
6,287,100

 
$
500,535

 
$
6,787,635

Acquisitions
3,997

 
37,587

 
41,584

Divestitures
(1,549
)
 
(6,744
)
 
(8,293
)
Foreign currency and other adjustments
—

 
(30,320
)
 
(30,320
)
Balance at June 30, 2020
$
6,289,548

 
$
501,058

 
$
6,790,606

 
 
 
 
 
 
Goodwill
$
6,289,548

 
$
626,224

 
$
6,915,772

Accumulated impairment charges
—

 
(125,166
)
 
(125,166
)
 
$
6,289,548

 
$
501,058

 
$
6,790,606