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Acquisitions - Components of Routine Acquisitions (Details) $ in Thousands | 12 Months Ended
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Dec. 31, 2022 USD ($) Clinic | Dec. 31, 2021 USD ($) Clinic | Dec. 31, 2020 USD ($) Clinic
Business Acquisition [Line Items] |  |  |
Cash paid to acquire business | $ 57,308 | $ 187,050 | $ 182,013
Series of individually immaterial business acquisitions |  |  |
Business Acquisition [Line Items] |  |  |
Cash paid to acquire business | 57,308 | 187,050 | 182,013
Business combination contingent consideration acquisitions, earn-outs | 4,261 | 14,854 | 14,042
Deferred Purchase price and liabilities assumed | 15,076 | 10,226 | 20,415
Non-cash gain on acquiring additional ownership in business acquisition | 0 | 0 | 1,821
Aggregate purchase cost recognized | $ 76,645 | $ 212,130 | $ 218,291
Series of individually immaterial business acquisitions | U.S. dialysis |  |  |
Business Acquisition [Line Items] |  |  |
Number of businesses acquired | Clinic | 5 | 19 | 8
Series of individually immaterial business acquisitions | Foreign Dialysis Centers |  |  |
Business Acquisition [Line Items] |  |  |
Number of businesses acquired | Clinic | 11 | 17 | 66

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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 https://asc.fasb.org/extlink&oid=126966197&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 https://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 https://asc.fasb.org/extlink&oid=126975305&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 https://asc.fasb.org/extlink&oid=126966197&loc=d3e6613-128477 + Details
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