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Goodwill Goodwill - Schedule of Reporting Units Goodwill Balances (Details) (Details) - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2019
Dec. 31, 2018
Dec. 31, 2017
Goodwill [Line Items]      
Goodwill $ 6,765,659 $ 6,841,960 $ 6,610,279
Percentage Change In Operating Income Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment 3.00%    
Percentage Change In Discount Rate Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment 1.00%    
BRAZIL | Kidney Care      
Goodwill [Line Items]      
Goodwill $ 287,256    
Reporting Unit Percentage Of Fair Value In Excess Of Short Of Carrying Amount 0.00%    
Potential Impact On Fair Value For Reduction In Operating Income (1.30%)    
Potential Impact On Fair Value For Basis Point Increase In Discount Rate (11.00%)    
GERMANY | Kidney Care      
Goodwill [Line Items]      
Goodwill $ 72,461    
Reporting Unit Percentage Of Fair Value In Excess Of Short Of Carrying Amount 4.40%    
Potential Impact On Fair Value For Reduction In Operating Income (2.80%)    
Potential Impact On Fair Value For Basis Point Increase In Discount Rate (7.00%)