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Goodwill (Tables)
 3 Months Ended
Mar. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments [Text Block] 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 December 31, 2017
$
6,144,761

 
$
465,518

 
$
6,610,279

Acquisitions
130,574

 
147,774

 
278,348

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

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

 
(28,064
)
 
(28,064
)
Balance at December 31, 2018
$
6,275,004

 
$
566,956

 
$
6,841,960

Acquisitions
7,027

 
1,628

 
8,655

Impairment charges
—

 
(41,037
)
 
(41,037
)
Foreign currency and other adjustments
—

 
(10,210
)
 
(10,210
)
Balance at March 31, 2019
$
6,282,031

 
$
517,337

 
$
6,799,368

 
 
 
 
 
 
Balance at March 31, 2019:
 
 
 
 
 
Goodwill
$
6,282,031

 
$
585,347

 
$
6,867,378

Accumulated impairment charges
—

 
(68,010
)
 
(68,010
)
 
$
6,282,031

 
$
517,337

 
$
6,799,368
Schedule Of Reporting Units Goodwill Balances [Text Block]
Reporting unit
 
Goodwill balance as
of March 31, 2019
 
Carrying amount
coverage(1)
 
Sensitivities
Operating income(2)
 
Discount rate(3)
Germany Kidney Care
 
$
354,182

 
—%
 
(1.4)%
 
(9.3)%
 
 
(1)
Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date.
(2)
Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
(3)
Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.