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Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Segment Reporting Information [Line Items]        
Other revenues $ 121,782 $ 118,889 $ 249,738 $ 232,312
Total revenues 2,879,979 2,842,705 5,721,216 5,585,817
Operating income (loss) 409,920 461,886 875,296 802,393
Corporate administrative support (73,088) (22,021) (96,672) (40,866)
Debt expense (81,381) (131,666) (169,984) (263,185)
Debt prepayment charges 0 12,160 2,948 12,160
Other income, net 9,545 5,643 5,195 12,583
Income from continuing operations before income taxes 338,084 323,703 707,559 539,631
U.S. dialysis        
Segment Reporting Information [Line Items]        
Total revenues 2,639,515 2,607,160 5,223,897 5,123,670
Other—Ancillary services        
Segment Reporting Information [Line Items]        
Total revenues 240,464 235,545 497,319 462,147
Operating Segments        
Segment Reporting Information [Line Items]        
Total revenues 2,919,579 2,876,442 5,797,210 5,653,531
Operating income (loss) 483,008 483,907 971,968 843,259
Operating Segments | U.S. dialysis        
Segment Reporting Information [Line Items]        
Dialysis patient service revenues 2,666,949 2,631,993 5,278,129 5,174,239
Total revenues 2,674,944 2,637,494 5,291,567 5,184,645
Operating income (loss) 522,630 498,957 1,014,236 915,939
Operating Segments | U.S. dialysis | External Sources        
Segment Reporting Information [Line Items]        
Dialysis patient service revenues 2,631,827 2,601,951 5,211,067 5,113,777
Other revenues 7,688 5,209 12,830 9,893
Operating Segments | U.S. dialysis | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Dialysis patient service revenues 35,122 30,042 67,062 60,462
Other revenues 307 292 608 513
Operating Segments | Other—Ancillary services        
Segment Reporting Information [Line Items]        
Dialysis patient service revenues 126,370 121,865 260,411 239,728
Other revenues 114,094 113,680 236,908 222,419
Total revenues 244,635 238,948 505,643 468,886
Operating income (loss) (39,622) (15,050) (42,268) (72,680)
Operating Segments | Other—Ancillary services | Intersubsegment Eliminations        
Segment Reporting Information [Line Items]        
Dialysis patient service revenues 4,171 3,403 8,324 6,739
Intersegment Elimination        
Segment Reporting Information [Line Items]        
Total revenues (39,600) (33,737) (75,994) (67,714)
Intersegment Elimination | U.S. dialysis        
Segment Reporting Information [Line Items]        
Total revenues (35,429) (30,334) (67,670) (60,975)
Intersegment Elimination | Other—Ancillary services        
Segment Reporting Information [Line Items]        
Total revenues $ (4,171) $ (3,403) $ (8,324) $ (6,739)