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Goodwill (Tables)
3 Months Ended
Mar. 31, 2021
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. dialysisOther - Ancillary servicesConsolidated
Balance at December 31, 2019$6,287,100 $500,535 $6,787,635 
Acquisitions24,377 105,680 130,057 
Divestitures(1,549)(6,744)(8,293)
Foreign currency and other adjustments— 9,710 9,710 
Balance at December 31, 2020$6,309,928 $609,181 $6,919,109 
Acquisitions— 5,456 5,456 
Foreign currency and other adjustments— (33,356)(33,356)
Balance at March 31, 2021$6,309,928 $581,281 $6,891,209 
Balance at March 31, 2021:
Goodwill$6,309,928 $711,854 $7,021,782 
Accumulated impairment charges— (130,573)(130,573)
$6,309,928 $581,281 $6,891,209