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Goodwill (Tables)
9 Months Ended
Sep. 30, 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 
Acquisitions12,423 41,196 53,619 
Divestitures(623)— (623)
Foreign currency and other adjustments— (31,438)(31,438)
Balance at September 30, 2021$6,321,728 $618,939 $6,940,667 
Balance at September 30, 2021:
Goodwill$6,321,728 $747,933 $7,069,661 
Accumulated impairment charges— (128,994)(128,994)
$6,321,728 $618,939 $6,940,667