Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Goodwill [Roll Forward]
Beginning balance	$ 6,841,960	$ 6,610,279	$ 6,610,279
Acquisitions	8,655		278,348
Divestitures			(15,497)
Impairment charges	(41,037)	0	(3,106)
Foreign currency and other adjustments	(10,210)		(28,064)
Ending balance	6,799,368		6,841,960
Goodwill	6,867,378
Accumulated impairment charges	(68,010)
Ending balance	6,799,368		6,841,960
U.S. dialysis and related lab services
Goodwill [Roll Forward]
Beginning balance	6,275,004	6,144,761	6,144,761
Acquisitions	7,027		130,574
Divestitures			(331)
Impairment charges	0		0
Foreign currency and other adjustments	0		0
Ending balance	6,282,031		6,275,004
Goodwill	6,282,031
Accumulated impairment charges	0
Ending balance	6,282,031		6,275,004
Other—Ancillary services and strategic initiatives
Goodwill [Roll Forward]
Beginning balance	566,956	$ 465,518	465,518
Acquisitions	1,628		147,774
Divestitures			(15,166)
Impairment charges	(41,037)		(3,106)
Foreign currency and other adjustments	(10,210)		(28,064)
Ending balance	517,337		566,956
Goodwill	585,347
Accumulated impairment charges	(68,010)
Ending balance	$ 517,337		$ 566,956

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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