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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Sep. 30, 2019
Dec. 31, 2018
Dec. 31, 2017
Business Acquisition [Line Items]      
Goodwill $ 6,765,659 $ 6,841,960 $ 6,610,279
Dialysis and other businesses      
Business Acquisition [Line Items]      
Current assets 5,238    
Property and equipment 3,607    
Intangible and other long-term assets 15,848    
Goodwill 77,238    
Current liabilities (3,360)    
Long-term liabilities (1,139)    
Noncontrolling interests (1,762)    
Aggregate purchase price $ 95,670