Acquisitions - Components of Routine Acquisitions (Details) $ in Thousands	12 Months Ended
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

Business Combination Contingent Consideration Acquisitions, Earn-out Obligations and Assumed Liabilities.

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Amount of liabilities incurred by the acquirer as part of consideration transferred in a business combination.

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Amount recognized as of the acquisition date for the identifiable assets acquired in excess of (less than) the aggregate liabilities assumed.

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In a business combination achieved in stages, this element represents the amount of gain recognized by the entity as a result of remeasuring to fair value the equity interest in the acquiree it held before the business combination.

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The number of businesses acquired by the entity during the period.

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The cash outflow associated with the acquisition of business during the period. The cash portion only of the acquisition price.

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