Long-term debt - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end	5.14%
Weighted average effective interest rate during quarter	5.16%
Percentage of debt instruments bearing fixed interest rate	46.31%
U.S. dialysis and related lab services
Debt Instrument [Line Items]
Letters of credit outstanding	$ 40,871
DMG
Debt Instrument [Line Items]
Letters of credit outstanding	211
Revolving Credit Facility
Debt Instrument [Line Items]
Proceeds from Long-term Lines of Credit	575,000
Undrawn revolving credit facilities	1,000,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding	$ 38,017
Senior Secured Credit Facilities
Debt Instrument [Line Items]
Weighted average effective interest rate at quarter end	5.00%
Term Loan A
Debt Instrument [Line Items]
Mandatory principal payments	$ 25,000
Secured Debt	650,000	$ 675,000
Term Loan B
Debt Instrument [Line Items]
Mandatory principal payments	8,750
Secured Debt	3,333,750	$ 3,342,500
Term Loan A subject to uncapped portion of variability of LIBOR
Debt Instrument [Line Items]
Secured Debt	483,750
Maximum
Debt Instrument [Line Items]
Unrestricted Proceeds From Divestiture Of Business	$ 750,000

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