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Acquisitions and divestitures Contingent Earn-out obligations (Details) - Dialysis and other businesses - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2021 | Sep. 30, 2021
Business Acquisition [Line Items] |  |
Contingent Earn-out Obligations, Beginning balance | $ 28,342 | $ 30,248
Acquisitions | 487 | 3,181
Foreign currency translation | (1,954) | (979)
Fair value remeasurements | (1,166) | (1,320)
Payments | (2,952) | (8,373)
Contingent Earn-out Obligations, Ending balance | $ 22,757 | $ 22,757

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