Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Disaggregation of Revenue [Line Items]
Other revenues	$ 116,658	$ 98,553	$ 217,932	$ 203,967
Total revenues	2,926,757	2,916,510	5,744,312	5,736,511
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(19,389)	(21,317)	(41,558)	(52,614)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,529,534	1,562,164	2,993,621	3,042,461
Other revenues	93,262	80,211	176,859	165,807
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	186,873	194,641	376,528	381,884
Other revenues	232	305	769	605
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	202,732	200,781	400,427	387,794
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	910,370	881,618	1,797,372	1,768,595
Other revenues	8,207	1,189	9,546	7,223
Other
Disaggregation of Revenue [Line Items]
Other revenues	14,936	16,918	30,748	34,756
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,643,851	2,655,021	5,196,778	5,217,897
U.S. dialysis \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(19,389)	(21,317)	(41,558)	(48,320)
U.S. dialysis \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,529,534	1,562,164	2,993,621	3,042,461
U.S. dialysis \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	186,873	194,641	376,528	381,884
U.S. dialysis \| Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	86,079	82,317	166,879	162,501
U.S. dialysis \| Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	854,662	830,801	1,689,240	1,666,280
U.S. dialysis \| Other
Disaggregation of Revenue [Line Items]
Other revenues	6,092	6,415	12,068	13,091
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	282,906	261,489	547,534	518,614
Other—Ancillary services \| Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues		0		(4,294)
Other—Ancillary services \| Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	93,262	80,211	176,859	165,807
Other—Ancillary services \| Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	232	305	769	605
Other—Ancillary services \| Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	116,653	118,464	233,548	225,293
Other—Ancillary services \| Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	55,708	50,817	108,132	102,315
Other revenues	8,207	1,189	9,546	7,223
Other—Ancillary services \| Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 8,844	$ 10,503	$ 18,680	$ 21,665