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Acquisitions and divestitures (Tables)
 3 Months Ended
Mar. 31, 2019
Dialysis and other businesses  
Business Acquisition [Line Items]  
Assets Acquired and Liabilities Assumed in Business Acquisitions The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values: 
Current assets
$
1,117

Property and equipment
923

Intangible and other long-term assets
4,312

Goodwill
8,655

Current liabilities
(592
)
Long-term liabilities
(88
)
Noncontrolling interests
(1,762
)

$
12,565