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Acquisitions - Components of Routine Acquisitions (Details) $ in Thousands | 12 Months Ended
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Dec. 31, 2021 USD ($) Clinic | Dec. 31, 2020 USD ($) Clinic | Dec. 31, 2019 USD ($) Clinic
Business Acquisition [Line Items] |  |  |
Cash paid to acquire business | $ 187,050 | $ 182,013 | $ 100,861
Series of individually immaterial business acquisitions |  |  |
Business Acquisition [Line Items] |  |  |
Cash paid to acquire business | 187,050 | 182,013 | 98,836
Business combination contingent consideration acquisitions, earn-outs | 14,854 | 14,042 | 23,536
Deferred Purchase price and liabilities assumed | 10,226 | 20,415 | 4,326
Non-cash gain on acquiring additional ownership in business acquisition | 0 | 1,821 | 0
Aggregate purchase cost recognized | $ 212,130 | $ 218,291 | $ 126,698
Series of individually immaterial business acquisitions | U.S. dialysis |  |  |
Business Acquisition [Line Items] |  |  |
Number of businesses acquired | Clinic | 19 | 8 | 7
Series of individually immaterial business acquisitions | Foreign Dialysis Centers |  |  |
Business Acquisition [Line Items] |  |  |
Number of businesses acquired | Clinic | 17 | 66 | 16

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- Definition Amount of liabilities incurred by the acquirer as part of consideration transferred in a business combination. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 805 -SubTopic 30 -Section 30 -Paragraph 7 -URI http://asc.fasb.org/extlink&oid=116859721&loc=d3e6578-128477 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 805 -SubTopic 30 -Section 25 -Paragraph 5 -URI http://asc.fasb.org/extlink&oid=6911189&loc=d3e6405-128476 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 805 -SubTopic 30 -Section 50 -Paragraph 1 -Subparagraph (b)(3) -URI http://asc.fasb.org/extlink&oid=120321790&loc=d3e6927-128479 Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 805 -SubTopic 30 -Section 30 -Paragraph 8 -URI http://asc.fasb.org/extlink&oid=116859721&loc=d3e6613-128477 + Details
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