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Acquisitions and divestitures - Additional Information (Detail) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2021 USD ($) clinic | Mar. 31, 2020 USD ($)
Business Acquisition [Line Items] |  |
Cash paid to acquire businesses | $ 3,668 | $ 34,107
Goodwill deductible for tax purposes associated with acquisitions | 5,456 |
Additional tax benefits recognized under the Coronavirus Aid, Relied, and Economic Security Act | 0 | $ 9,980
Other current liabilities |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | 11,613 |
Other long-term liabilities |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | 16,612 |
Other companies |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations | $ 28,225 |
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |
Business Acquisition [Line Items] |  |
Earn-out consideration payment period | 1 year |
Maximum |  |
Business Acquisition [Line Items] |  |
Contingent earn-out obligations and liabilities assumed associated with acquisitions | $ 40,173 |
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins |  |
Business Acquisition [Line Items] |  |
Earn-out consideration payment period | 5 years |
Dialysis and other businesses |  |
Business Acquisition [Line Items] |  |
Cash paid to acquire businesses | $ 3,668 |
Contingent earn-out obligations and liabilities assumed associated with acquisitions | 538 |
Deferred purchase price obligations | $ 1,094 |
Foreign Dialysis Centers | Dialysis and other businesses |  |
Business Acquisition [Line Items] |  |
Number of businesses acquired | clinic | 2 |

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