Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Roll Forward]
Beginning balance	$ 6,610,279	$ 6,015,375
Acquisitions	278,348	617,032
Divestitures	(15,497)	(32,386)
Impairment charges	(3,106)	(36,196)	$ (28,415)
Foreign currency and other adjustments	(28,064)	46,454
Ending balance	6,841,960	6,610,279	6,015,375
Goodwill	6,869,233
Accumulated impairment charges	(27,273)
U.S. dialysis and related lab services
Goodwill [Roll Forward]
Beginning balance	6,144,761	5,691,587
Acquisitions	130,574	485,434
Divestitures	(331)	(32,260)
Impairment charges	0	0
Foreign currency and other adjustments	0	0
Ending balance	6,275,004	6,144,761	5,691,587
Goodwill	6,275,004
Accumulated impairment charges	0
Other ancillary services and strategic initiatives
Goodwill [Roll Forward]
Beginning balance	465,518	323,788
Acquisitions	147,774	131,598
Divestitures	(15,166)	(126)
Impairment charges	(3,106)	(36,196)
Foreign currency and other adjustments	(28,064)	46,454
Ending balance	566,956	$ 465,518	$ 323,788
Goodwill	594,229
Accumulated impairment charges	$ (27,273)

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of increase in asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from a business combination.

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Amount of foreign currency translation gain (loss) which increases (decreases) an asset representing future economic benefits from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount before accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of accumulated impairment loss for an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of loss from the write-down of an asset representing the future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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A roll forward is a reconciliation of a concept from the beginning of a period to the end of a period.

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Amount of divestiture of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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