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Acquisitions and divestitures (Details) $ in Thousands | 3 Months Ended | 9 Months Ended
--- | --- | ---
Sep. 30, 2024 USD ($) | Sep. 30, 2023 USD ($) | Sep. 30, 2024 USD ($) Clinic | Sep. 30, 2023 USD ($)
Business Acquisition [Line Items] |  |  |  |
Cash paid to acquire businesses |  |  | $ 161,210 | $ 7,990
Gain on changes in ownership interest | $ 0 | $ 0 | 35,147 | $ 0
Dialysis and other businesses |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Cash paid to acquire businesses |  |  | 161,210 |
Business Combination Contingent Consideration Acquisitions |  |  | 296 |
Deferred purchase price obligations |  |  | 54,033 |
Business Combination, Step Acquisition, Equity Interest in Acquiree, Fair Value |  |  | 67,526 |
Gain on changes in ownership interest |  |  | $ 35,147 |
Dialysis and other businesses | U.S. dialysis |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Number of businesses acquired | Clinic |  |  | 12 |
Dialysis and other businesses | Foreign Dialysis Centers |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Number of businesses acquired | Clinic |  |  | 91 |

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