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Acquisitions and divestitures (Tables)
 9 Months Ended
Sep. 30, 2020
Business Acquisition [Line Items]  
Schedule of Business Acquisitions by Acquisition, Contingent Consideration
The following is a reconciliation of changes in contingent earn-out obligations for the three and nine month periods ended September 30, 2020:
 
Three months ended September 30, 2020
 
Nine months ended September 30, 2020
Beginning balance
$
24,057

 
$
24,586

Acquisitions
5,815

 
11,676

Foreign currency translation
(975
)
 
(6,358
)
Fair value remeasurements
(1,990
)
 
(2,630
)
Payments or other settlements
(593
)
 
(960
)
Ending balance
$
26,314

 
$
26,314
Dialysis and other businesses  
Business Acquisition [Line Items]  
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]
The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values: 
Current assets
$
17,606

Property and equipment
15,714

Intangible and other long-term assets
14,969

Goodwill
110,248

Deferred income taxes
1,513

Current liabilities
(17,786
)
Noncontrolling interests
(1,729
)

$
140,535