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Goodwill (Tables)
 9 Months Ended
Sep. 30, 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
24,377

 
85,871

 
110,248

Divestitures
(1,549
)
 
(6,744
)
 
(8,293
)
Foreign currency and other adjustments
—

 
(21,213
)
 
(21,213
)
Balance at September 30, 2020
$
6,309,928

 
$
558,449

 
$
6,868,377

 
 
 
 
 
 
Balance at September 30, 2020
 
 
 
 
 
Goodwill
$
6,309,928

 
$
688,881

 
$
6,998,809

Accumulated impairment charges
—

 
(130,432
)
 
(130,432
)
 
$
6,309,928

 
$
558,449

 
$
6,868,377