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Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Sep. 30, 2024 | Jun. 30, 2024 | Dec. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022
Segment Reporting Information [Line Items] |  |  |  |  |
Other revenues |  |  | $ 555,175 | $ 565,206 | $ 433,430
Total revenues |  |  | 12,815,550 | 12,140,147 | 11,609,894
Operating Income (Loss) |  |  | 2,090,483 | 1,602,784 | 1,339,062
Corporate administrative support |  |  | (113,181) | (163,047) | (129,669)
Debt expense |  |  | (470,469) | (398,551) | (357,019)
Debt prepayment, extinguishment and modification costs | $ (10,081) | $ (9,732) | (19,813) | (7,962) | 0
Other loss, net |  |  | (69,808) | (19,177) | (15,765)
Income from continuing operations before income taxes |  |  | 1,530,393 | 1,177,094 | 966,278
Segment Reporting Information footnote: |  |  |  |  |
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. |  |  | 26,189 | 27,864 | 26,520
Patient care costs |  |  | 8,598,521 | 8,319,717 | 8,209,553
General and administrative |  |  | 1,538,341 | 1,473,984 | 1,355,197
Operating expenses and charges |  |  | 10,725,067 | 10,537,363 | 10,270,832
Depreciation and amortization |  |  | 723,860 | 745,443 | 732,602
Property and equipment, net of accumulated depreciation |  |  | 2,940,916 | 3,073,533 |
Other - Ancillary services |  |  |  |  |
Segment Reporting Information footnote: |  |  |  |  |
Depreciation and amortization |  |  | 62,679 | 49,769 | 41,653
Operating Segments |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Total revenues |  |  | 12,901,207 | 12,236,221 | 11,701,135
Operating Income (Loss) |  |  | 2,203,664 | 1,765,831 | 1,468,731
Operating Segments | U.S. dialysis |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Operating Income (Loss) |  |  | 2,121,007 | 1,774,578 | 1,565,310
Segment Reporting Information footnote: |  |  |  |  |
Patient care costs |  |  | 7,497,576 | 7,394,640 | 7,334,415
General and administrative |  |  | 1,173,990 | 1,102,072 | 1,037,552
Segment Reporting, Other Segment Item, Amount |  |  | (63,037) | (29,966) | (28,417)
Operating expenses and charges |  |  | 9,269,710 | 9,162,420 | 9,034,499
Depreciation and amortization |  |  | 661,181 | 695,674 | 690,949
Operating Segments | Other - Ancillary services |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Operating Income (Loss) |  |  | 82,657 | (8,747) | (96,579)
Segment Reporting Information footnote: |  |  |  |  |
Equity investment income (loss) from equity method investments in nonconsolidated dialysis partnerships. |  |  | (1,701) | (2,103) | (1,898)
Operating expenses and charges |  |  | 1,427,833 | 1,307,970 | 1,197,905
Operating Segments | U S Dialysis And Related Lab Services with Intersegment |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Dialysis patient service revenues |  |  | 11,366,361 | 10,911,747 | 10,575,372
Total revenues |  |  | 11,390,717 | 10,936,998 | 10,599,809
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | External Sources |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Dialysis patient service revenues |  |  | 11,294,614 | 10,823,525 | 10,488,327
Other revenues |  |  | 24,356 | 25,251 | 24,447
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | Intersubsegment Eliminations |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Dialysis patient service revenues |  |  | 71,747 | 88,222 | 87,045
Other revenues |  |  | 0 | 0 | (10)
Operating Segments | Other Operating Segments with Intersegment |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Dialysis patient service revenues |  |  | 965,761 | 751,416 | 688,137
Other revenues |  |  | 530,819 | 539,955 | 408,983
Total revenues |  |  | 1,510,490 | 1,299,223 | 1,101,326
Operating Segments | Other Operating Segments with Intersegment | Intersubsegment Eliminations |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Dialysis patient service revenues |  |  | 13,910 | 7,852 | 4,206
Intersegment Elimination |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Total revenues |  |  | $ (85,657) | $ (96,074) | $ (91,241)

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