Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Noncontrolling Interest [Line Items]
Carrying value of investment in APAC	$ 0	$ 0
Equity investments in nonconsolidated businesses	245,534	492,039
Equity investment (loss) income	(8,640)	16,874	$ 13,919
Deconsolidated Noncontrolling Entity [Member]
Noncontrolling Interest [Line Items]
Equity investments in nonconsolidated businesses	245,534	492,039
Equity investment (loss) income	(8,640)	16,874	$ 13,919
Company and Restricted Subsidiaries(1)
Noncontrolling Interest [Line Items]
Impairment related to minority equity investment		$ 14,993
Asia-Pacific dialysis business \| Deconsolidated Noncontrolling Entity [Member]
Noncontrolling Interest [Line Items]
Non-cash other than temporary impairment losses	280,066
Carrying value of investment in APAC	$ 160,481

This item represents an other than temporary decline in value that has been recognized against an investment accounted for under the equity method of accounting. The excess of the carrying amount over the fair value of the investment represents the amount of the write down which is or was reflected in earnings. The written down value is a new cost basis with the adjusted value of the investment becoming its new carrying value subject to the equity accounting method. Evidence of a loss in value might include, but would not necessarily be limited to, absence of an ability to recover the carrying amount of the investment or inability of the investee to sustain an earnings capacity which would justify the carrying amount of the investment.

Reference 1: http://www.xbrl.org/2003/role/presentationRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
-SubTopic 10
-Section 35
-Paragraph 32
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This item represents the carrying amount on the entity's balance sheet of its investment in common stock of an equity method investee. This is not an indicator of the fair value of the investment, rather it is the initial cost adjusted for the entity's share of earnings and losses of the investee, adjusted for any distributions (dividends) and other than temporary impairment (OTTI) losses recognized.

+ References

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The amount by which the fair value of an investment is less than the amortized cost basis or carrying amount of that investment at the balance sheet date and the decline in fair value is deemed to be other than temporary, before considering whether or not such amount is recognized in earnings or other comprehensive income.

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Total investments in (A) an entity in which the entity has significant influence, but does not have control, (B) subsidiaries that are not required to be consolidated and are accounted for using the equity and or cost method, and (C) an entity in which the reporting entity shares control of the entity with another party or group. Includes long-term advances receivable from a party that is affiliated with the reporting entity by means of direct or indirect ownership.

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