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Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | 12 Months Ended
--- | --- | --- | ---
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | Dec. 31, 2019
Goodwill [Roll Forward] |  |  |  |  |
Beginning balance |  |  | $ 6,787,635 | $ 6,841,960 | $ 6,841,960
Acquisitions |  |  | 110,248 |  | 90,226
Impairment charges | $ 0 | $ (83,855) | 0 | (124,892) | (124,892)
Foreign currency and other adjustments |  |  | (21,213) |  | (19,659)
Divestitures |  |  | (8,293) |  |
Ending balance | 6,868,377 |  | 6,868,377 |  | 6,787,635
Goodwill, before accumulated impairment charges | 6,998,809 |  | 6,998,809 |  |
Accumulated impairment charges | (130,432) |  | (130,432) |  |
Ending balance | 6,868,377 |  | 6,868,377 |  | 6,787,635
U.S. dialysis |  |  |  |  |
Goodwill [Roll Forward] |  |  |  |  |
Beginning balance |  |  | 6,287,100 | 6,275,004 | 6,275,004
Acquisitions |  |  | 24,377 |  | 18,089
Impairment charges |  |  |  |  | 0
Foreign currency and other adjustments |  |  | 0 |  | (5,993)
Divestitures |  |  | (1,549) |  |
Ending balance | 6,309,928 |  | 6,309,928 |  | 6,287,100
Goodwill, before accumulated impairment charges | 6,309,928 |  | 6,309,928 |  |
Accumulated impairment charges | 0 |  | 0 |  |
Ending balance | 6,309,928 |  | 6,309,928 |  | 6,287,100
Other—Ancillary services |  |  |  |  |
Goodwill [Roll Forward] |  |  |  |  |
Beginning balance |  |  | 500,535 | $ 566,956 | 566,956
Acquisitions |  |  | 85,871 |  | 72,137
Impairment charges |  |  |  |  | (124,892)
Foreign currency and other adjustments |  |  | (21,213) |  | (13,666)
Divestitures |  |  | (6,744) |  |
Ending balance | 558,449 |  | 558,449 |  | 500,535
Goodwill, before accumulated impairment charges | 688,881 |  | 688,881 |  |
Accumulated impairment charges | (130,432) |  | (130,432) |  |
Ending balance | $ 558,449 |  | $ 558,449 |  | $ 500,535

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