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Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Goodwill [Line Items]      
Goodwill $ 6,841,960 $ 6,610,279 $ 6,015,375
Percentage change in operating income used to evaluate fair value of reporting unit for goodwill assessment 3.00%    
Percentage change in discount rate used to evaluate fair value of reporting unit for goodwill assessment 1.00%    
Kidney Care | GERMANY      
Goodwill [Line Items]      
Goodwill $ 403,200    
Carrying amount coverage 0.50%    
Sensitivities, Operating Income (1.50%)    
Sensitivities, Discount rate (10.30%)    
Kidney Care | BRAZIL      
Goodwill [Line Items]      
Goodwill $ 39,452    
Carrying amount coverage 9.80%    
Sensitivities, Operating Income (2.50%)    
Sensitivities, Discount rate (7.30%)    
International Operations | GERMANY      
Goodwill [Line Items]      
Goodwill $ 12,646    
Carrying amount coverage 8.10%    
Sensitivities, Operating Income (2.20%)    
Sensitivities, Discount rate (11.10%)