Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disaggregation of Revenue [Line Items]
Other revenues	$ 142,416	$ 126,886	$ 392,154	$ 359,198
Total revenues	2,924,066	2,904,078	8,645,282	8,489,895
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(41,396)	(35,845)	(117,389)	(103,559)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,510,982	1,558,890	4,530,510	4,572,599
Other revenues	111,248	65,759	309,555	191,472
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	193,254	176,292	547,045	490,723
Other revenues	412	227	1,061	327
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	212,371	207,931	626,427	597,866
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	902,092	866,229	2,653,257	2,562,120
Other revenues	7,799	33,503	27,370	98,428
Other
Disaggregation of Revenue [Line Items]
Other revenues	27,304	31,092	67,446	79,919
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,656,902	2,659,065	7,880,798	7,782,735
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(37,317)	(32,362)	(104,987)	(93,337)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,510,982	1,558,890	4,530,510	4,572,599
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	193,254	176,292	547,045	490,723
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	114,327	116,984	342,996	333,675
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	858,247	828,953	2,534,388	2,458,360
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	17,409	10,308	30,846	20,715
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	267,164	245,013	764,484	707,160
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(4,079)	(3,483)	(12,402)	(10,222)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	111,248	65,759	309,555	191,472
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	412	227	1,061	327
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	98,044	90,947	283,431	264,191
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	43,845	37,276	118,869	103,760
Other revenues	7,799	33,503	27,370	98,428
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 9,895	$ 20,784	$ 36,600	$ 59,204