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Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2025
Mar. 31, 2024
Segment Reporting Information [Line Items]    
Other revenues $ 120,536 $ 129,023
Total revenues 3,223,529 3,070,555
Operating income (loss) 438,937 483,845
Corporate administrative support (34,026) (30,390)
Debt expense (135,055) (99,418)
Other loss, net (17,549) (12,641)
Income before income taxes 286,333 371,786
Patient care costs 2,239,660 2,078,976
Depreciation and amortization 176,451 187,083
Operating expenses 2,784,592 2,586,710
U S Dialysis And Related Lab Services [Member]    
Segment Reporting Information [Line Items]    
Total revenues 2,811,435 2,731,697
Depreciation and amortization 156,899 172,852
Other Operating Segment [Member]    
Segment Reporting Information [Line Items]    
Total revenues 412,094 338,858
Depreciation and amortization 19,552 14,231
Operating Segments    
Segment Reporting Information [Line Items]    
Total revenues 3,237,991 3,097,765
Operating income (loss) 472,963 514,235
Operating Segments | U S Dialysis And Related Lab Services [Member]    
Segment Reporting Information [Line Items]    
Operating income (loss) 475,772 525,737
Patient care costs 1,913,428 1,824,579
Depreciation and amortization 282,679 274,562
Segment Reporting, Other Segment Item, Amount (5,609) (41,570)
Operating expenses 2,347,397 2,230,423
Operating Segments | Other Operating Segment [Member]    
Segment Reporting Information [Line Items]    
Operating income (loss) (2,809) (11,502)
Operating expenses 417,631 353,107
Operating Segments | U S Dialysis And Related Lab Services with Intersegment    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 2,817,161 2,750,038
Total revenues 2,823,169 2,756,160
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | External Sources    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 2,805,427 2,725,575
Other revenues 6,008 6,122
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 11,734 24,463
Operating Segments | Other Operating Segments with Intersegment    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 297,566 215,957
Other revenues 114,528 122,901
Total revenues 414,822 341,605
Operating Segments | Other Operating Segments with Intersegment | Intersubsegment Eliminations    
Segment Reporting Information [Line Items]    
Dialysis patient service revenues 2,728 2,747
Intersegment Elimination    
Segment Reporting Information [Line Items]    
Total revenues (14,462) (27,210)
Intersegment Elimination | U S Dialysis And Related Lab Services [Member]    
Segment Reporting Information [Line Items]    
Total revenues (11,734) (24,463)
Intersegment Elimination | Other Operating Segment [Member]    
Segment Reporting Information [Line Items]    
Total revenues $ (2,728) $ (2,747)