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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Amount after tax of loss recognized that results 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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Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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Amount of (increase) decrease to an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from the subsequent recognition of deferred tax assets.

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Number of operating segments. An operating segment is a component of an enterprise: (a) that engages in business activities from which it may earn revenues and incur expenses (including revenues and expenses relating to transactions with other components of the same enterprise), (b) whose operating results are regularly reviewed by the enterprise's chief operating decision maker to make decisions about resources to be allocated to the segment and assess its performance, and (c) for which discrete financial information is available. An operating segment may engage in business activities for which it has yet to earn revenues, for example, start-up operations may be operating segments before earning revenues.

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Goodwill - Narrative (Details) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
Goodwill - Narrative (Details) $ in Thousands	Jun. 30, 2019 USD ($)	Jun. 30, 2018 USD ($)	Jun. 30, 2019 USD ($) segment	Jun. 30, 2018 USD ($)	Dec. 31, 2018 USD ($)
Goodwill [Line Items]
Goodwill impairment charges	$ 0	$ 3,106	$ 41,037	$ 3,106	$ 3,106
Other Reporting Units
Goodwill [Line Items]
Goodwill impairment charges	$ 0
Number of Reportable Segments \| segment			0
GERMANY \| Other Reporting Units
Goodwill [Line Items]
Goodwill impairment charges				$ 3,106
GERMANY \| Kidney Care
Goodwill [Line Items]
Goodwill impairment charges			$ 41,037
Goodwill, Subsequent Recognition of Deferred Tax Asset			8,865
Goodwill, Impairment Loss, Net of Tax			$ 32,172