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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)