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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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- Definition

Business Combination Contingent Consideration Acquisitions Fair Value Remeasurement Gain Loss

+ References

No definition available.

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- Definition

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+ References

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- Definition

Amount of increase (decrease) in the value of right to a contingent consideration asset.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 230
-SubTopic 10
-Section 45
-Paragraph 28
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3602-108585

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 805
-SubTopic 30
-Section 50
-Paragraph 4
-Subparagraph (a)(1)
-URI http://asc.fasb.org/extlink&oid=120321790&loc=d3e7008-128479

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- Definition

Amount of increase (decrease) in the value of a contingent consideration liability, including, but not limited to, differences arising upon settlement.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 230
-SubTopic 10
-Section 45
-Paragraph 28
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3602-108585

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 805
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-Section 50
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- Definition

For contingent consideration arrangements recognized in connection with a business combination, this element represents an estimate of the high-end of the potential range (undiscounted) of the consideration which may be paid.

+ References

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 805
-SubTopic 30
-Section 50
-Paragraph 1
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-URI http://asc.fasb.org/extlink&oid=120321790&loc=d3e6927-128479

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