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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 | 6 Months Ended
--- | --- | ---
Jun. 30, 2025 | Jun. 30, 2024 | Jun. 30, 2025 | Jun. 30, 2024
Segment Reporting Information [Line Items] |  |  |  |
Other revenues | $ 172,655 | $ 125,620 | $ 293,191 | $ 254,643
Total revenues | 3,379,526 | 3,186,722 | 6,603,055 | 6,257,277
Operating income (loss) | 537,841 | 506,398 | 976,778 | 990,243
Corporate administrative support | (41,717) | (25,196) | (75,745) | (55,586)
Debt expense | (146,062) | (97,747) | (281,117) | (197,165)
Debt prepayment, extinguishment and modification costs | 0 | (9,732) | 0 | (9,732)
Other loss, net | (22,851) | (27,479) | (40,400) | (40,120)
Income before income taxes | 368,928 | 371,440 | 655,261 | 743,226
Patient care costs | 2,261,540 | 2,142,299 | 4,501,200 | 4,221,275
General and administrative | 412,805 | 367,845 | 786,895 | 730,325
Depreciation and amortization | 174,704 | 175,661 | 351,155 | 362,744
Operating expenses | 2,841,685 | 2,680,324 | 5,626,277 | 5,267,034
U. S. Dialysis And Related Lab Services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 2,896,675 | 2,828,085 | 5,708,110 | 5,559,782
Depreciation and amortization | 156,782 | 160,410 | 313,681 | 333,262
Other Operating Segment |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 482,851 | 358,637 | 894,945 | 697,495
Depreciation and amortization | 17,923 | 15,251 | 37,474 | 29,482
Operating Segments |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | 3,399,078 | 3,203,470 | 6,637,070 | 6,301,236
Operating income (loss) | 579,558 | 531,594 | 1,052,523 | 1,045,829
Operating Segments | U. S. Dialysis And Related Lab Services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Operating income (loss) | 522,844 | 550,186 | 998,617 | 1,075,923
Patient care costs | 1,928,462 | 1,854,541 | 3,841,890 | 3,679,120
General and administrative | 312,089 | 281,795 | 594,768 | 556,357
Segment Reporting, Other Segment Item, Amount | (6,786) | (5,922) | (12,396) | (47,491)
Operating expenses | 2,390,547 | 2,290,824 | 4,737,943 | 4,521,248
Operating Segments | Other Operating Segment |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Operating income (loss) | 56,714 | (18,592) | 53,906 | (30,094)
Operating expenses | 428,973 | 381,052 | 846,604 | 734,159
Operating Segments | U S Dialysis And Related Lab Services with Intersegment |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis patient service revenues | 2,907,425 | 2,835,112 | 5,724,586 | 5,585,150
Total revenues | 2,913,391 | 2,841,010 | 5,736,560 | 5,597,171
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | External Sources |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis patient service revenues | 2,890,709 | 2,822,187 | 5,696,136 | 5,547,761
Other revenues | 5,966 | 5,898 | 11,974 | 12,021
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | Intersubsegment Eliminations |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis patient service revenues | 16,716 | 12,925 | 28,450 | 37,389
Operating Segments | Other Operating Segments with Intersegment |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis patient service revenues | 316,162 | 238,915 | 613,728 | 454,873
Other revenues | 166,689 | 119,722 | 281,217 | 242,622
Total revenues | 485,687 | 362,460 | 900,510 | 704,065
Operating Segments | Other Operating Segments with Intersegment | Intersubsegment Eliminations |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Dialysis patient service revenues | 2,836 | 3,823 | 5,565 | 6,570
Intersegment Elimination |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | (19,552) | (16,748) | (34,015) | (43,959)
Intersegment Elimination | U. S. Dialysis And Related Lab Services |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | (16,716) | (12,925) | (28,450) | (37,389)
Intersegment Elimination | Other Operating Segment |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |
Total revenues | $ (2,836) | $ (3,823) | $ (5,565) | $ (6,570)

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