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Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2025
Jun. 30, 2024
Jun. 30, 2025
Jun. 30, 2024
Disaggregation of Revenue [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
Contract with Customer, Performance Obligation Satisfied in Previous Period     95,911 31,309
Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (19,552) (16,748) (34,015) (43,959)
Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,659,607 1,587,198 3,268,625 3,118,696
Other revenues 140,149 97,433 239,103 200,542
Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 217,699 214,951 424,208 425,075
Other revenues 0 445 2 841
Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 308,041 256,862 595,151 485,233
Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,038,240 1,015,016 2,050,330 2,011,019
Other revenues 8,322 10,200 11,023 17,140
Other        
Disaggregation of Revenue [Line Items]        
Other revenues 27,020 21,365 48,628 42,690
U. S. Dialysis And Related Lab Services        
Disaggregation of Revenue [Line Items]        
Total revenues 2,896,675 2,828,085 5,708,110 5,559,782
U. S. Dialysis And Related Lab Services | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (16,716) (12,925) (28,450) (37,389)
U. S. Dialysis And Related Lab Services | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 1,659,607 1,587,198 3,268,625 3,118,696
U. S. Dialysis And Related Lab Services | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 217,699 214,951 424,208 425,075
U. S. Dialysis And Related Lab Services | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 83,104 80,338 159,850 162,924
U. S. Dialysis And Related Lab Services | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 947,015 952,625 1,871,903 1,878,455
U. S. Dialysis And Related Lab Services | Other        
Disaggregation of Revenue [Line Items]        
Other revenues 5,966 5,898 11,974 12,021
Other Operating Segment        
Disaggregation of Revenue [Line Items]        
Total revenues 482,851 358,637 894,945 697,495
Other Operating Segment | Elimination of intersegment revenues        
Disaggregation of Revenue [Line Items]        
Total revenues (2,836) (3,823) (5,565) (6,570)
Other Operating Segment | Medicare and Medicare Advantage        
Disaggregation of Revenue [Line Items]        
Other revenues 140,149 97,433 239,103 200,542
Other Operating Segment | Medicaid and Managed Medicaid        
Disaggregation of Revenue [Line Items]        
Other revenues 0 445 2 841
Other Operating Segment | Other Government Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 224,937 176,524 435,301 322,309
Other Operating Segment | Commercial Payors        
Disaggregation of Revenue [Line Items]        
Dialysis patient service revenues 91,225 62,391 178,427 132,564
Other revenues 8,322 10,200 11,023 17,140
Other Operating Segment | Other        
Disaggregation of Revenue [Line Items]        
Other revenues $ 21,054 $ 15,467 $ 36,654 $ 30,669