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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