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Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Sep. 30, 2024
Sep. 30, 2023
Disaggregation of Revenue [Line Items]        
Other revenues $ 125,029 $ 169,382 $ 379,672 $ 391,731
Total revenues 3,263,590 3,121,332 9,520,867 8,994,400
Contract with Customer, Performance Obligation Satisfied in Previous Period     58,403 75,949
Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (18,738) (26,521) (62,696) (71,705)
Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,641,645 1,515,860 4,760,340 4,538,264
Other revenues 104,217 137,149 304,760 317,624
Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 216,664 207,327 641,738 629,118
Other revenues (25) 331 816 1,296
Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 282,937 219,529 768,170 641,649
Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,013,455 1,033,523 3,024,475 2,860,336
Other revenues 3,735 16,063 20,875 20,888
Other        
Disaggregation of Revenue [Line Items]        
Other revenues 19,700 18,071 62,389 56,930
U.S. dialysis        
Disaggregation of Revenue [Line Items]        
Total revenues 2,889,860 2,761,017 8,449,642 8,061,383
U.S. dialysis | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (16,140) (24,289) (53,528) (66,698)
U.S. dialysis | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,641,645 1,515,860 4,760,340 4,538,264
U.S. dialysis | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 216,664 207,327 641,738 629,118
U.S. dialysis | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 86,680 90,549 249,605 265,119
U.S. dialysis | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 954,807 965,331 2,833,263 2,676,758
U.S. dialysis | Other        
Disaggregation of Revenue [Line Items]        
Other revenues 6,204 6,239 18,224 18,822
Other—Ancillary services        
Disaggregation of Revenue [Line Items]        
Total revenues 373,730 360,315 1,071,225 933,017
Other—Ancillary services | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (2,598) (2,232) (9,168) (5,007)
Other—Ancillary services | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Other revenues 104,217 137,149 304,760 317,624
Other—Ancillary services | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Other revenues (25) 331 816 1,296
Other—Ancillary services | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 196,257 128,980 518,565 376,530
Other—Ancillary services | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 58,648 68,192 191,212 183,578
Other revenues 3,735 16,063 20,875 20,888
Other—Ancillary services | Other        
Disaggregation of Revenue [Line Items]        
Other revenues $ 13,496 $ 11,832 $ 44,165 $ 38,108