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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Jun. 30, 2019
Dec. 31, 2018
Dec. 31, 2017
Business Acquisition [Line Items]      
Goodwill $ 6,865,386 $ 6,841,960 $ 6,610,279
Dialysis and other businesses      
Business Acquisition [Line Items]      
Current assets 3,607    
Property and equipment 2,135    
Intangible and other long-term assets 8,443    
Goodwill 66,614    
Current liabilities (2,067)    
Long-term liabilities (88)    
Noncontrolling interests (1,762)    
Aggregate purchase price $ 76,882