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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
Mar. 31, 2021
Mar. 31, 2020
Segment Reporting Information [Line Items]    
Other revenues $ 105,414 $ 127,956
Total revenues 2,820,001 2,841,237
Operating income (loss) 442,602 465,376
Corporate administrative support (25,444) (23,585)
Debt expense (67,014) (88,603)
Debt refinancing charges 0 (2,948)
Other income (loss), net 1,168 (4,350)
Income from continuing operations before income taxes 376,756 369,475
U.S. dialysis    
Segment Reporting Information [Line Items]    
Total revenues 2,562,875 2,584,381
Other—Ancillary services    
Segment Reporting Information [Line Items]    
Total revenues 257,126 256,856
Operating Segments    
Segment Reporting Information [Line Items]    
Total revenues 2,851,297 2,877,631
Operating income (loss) 468,046 488,961
Operating Segments | U.S. dialysis    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 2,583,203 2,611,181
Total revenues 2,589,878 2,616,623
Operating income (loss) 479,906 491,607
Operating Segments | U.S. dialysis | External Sources    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 2,556,259 2,579,240
Other revenues 6,616 5,141
Operating Segments | U.S. dialysis | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 26,944 31,941
Other revenues 59 301
Operating Segments | Other—Ancillary services    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 158,328 134,041
Other revenues 98,798 122,815
Total revenues 261,419 261,008
Operating income (loss) (11,860) (2,646)
Operating Segments | Other—Ancillary services | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 4,293 4,152
Intersegment Elimination    
Segment Reporting Information [Line Items]    
Total revenues (31,296) (36,394)
Intersegment Elimination | U.S. dialysis    
Segment Reporting Information [Line Items]    
Total revenues (27,003) (32,242)
Intersegment Elimination | Other—Ancillary services    
Segment Reporting Information [Line Items]    
Total revenues $ (4,293) $ (4,152)