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Goodwill (Tables)
 3 Months Ended
Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Goodwill by Reportable Segments [Text Block]
Changes in goodwill by reportable segments were as follows:
 
U.S. dialysis
 
Other - Ancillary services
 
Consolidated
Balance at December 31, 2018
$
6,275,004

 
$
566,956

 
$
6,841,960

Acquisitions
18,089

 
72,137

 
90,226

Impairment charges
—

 
(124,892
)
 
(124,892
)
Foreign currency and other adjustments
(5,993
)
 
(13,666
)
 
(19,659
)
Balance at December 31, 2019
$
6,287,100

 
$
500,535

 
$
6,787,635

Acquisitions
2,839

 
23,931

 
26,770

Divestitures
(1,549
)
 
—

 
(1,549
)
Foreign currency and other adjustments
—

 
(34,833
)
 
(34,833
)
Balance at March 31, 2020
$
6,288,390

 
$
489,633

 
$
6,778,023

 
 
 
 
 
 
Goodwill
$
6,288,390

 
$
638,117

 
$
6,926,507

Accumulated impairment charges
—

 
(148,484
)
 
(148,484
)
 
$
6,288,390

 
$
489,633

 
$
6,778,023