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Goodwill (Tables)
 9 Months Ended
Sep. 30, 2018
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments
Changes in goodwill by reportable segment were as follows:
 
U.S. dialysis and
related lab services
 
Other-ancillary
services and
strategic initiatives
 
Consolidated total
Balance at January 1, 2017
$
5,691,587

 
$
323,788

 
$
6,015,375

Acquisitions
485,434

 
131,598

 
617,032

Divestitures
(32,260
)
 
(126
)
 
(32,386
)
Impairment charges
—

 
(36,196
)
 
(36,196
)
Foreign currency and other adjustments
—

 
46,454

 
46,454

Balance at December 31, 2017
$
6,144,761

 
$
465,518

 
$
6,610,279

Acquisitions
24,431

 
111,223

 
135,654

Divestitures
(331
)
 
(15,166
)
 
(15,497
)
Impairment charges
—

 
(3,106
)
 
(3,106
)
Foreign currency and other adjustments
—

 
(24,671
)
 
(24,671
)
Balance at September 30, 2018
$
6,168,861

 
$
533,798

 
$
6,702,659

 
 
 
 
 
 
Balance at September 30, 2018:
 
 
 
 
 
Goodwill
$
6,168,861

 
$
561,399

 
$
6,730,260

Accumulated impairment charges
—

 
(27,601
)
 
(27,601
)
 
$
6,168,861

 
$
533,798

 
$
6,702,659