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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Sep. 30, 2018
Dec. 31, 2017
Dec. 31, 2016
Business Acquisition [Line Items]      
Goodwill $ 6,702,659 $ 6,610,279 $ 6,015,375
Dialysis and other businesses      
Business Acquisition [Line Items]      
Current assets 10,183    
Property and equipment 5,654    
Intangible and other long-term assets 3,672    
Goodwill 135,654    
Current liabilities (12,139)    
Long-term liabilities (212)    
Noncontrolling interests (11,947)    
Aggregate purchase price $ 130,865