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Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($)
$ in Thousands
Sep. 30, 2020
Dec. 31, 2019
Dec. 31, 2018
Business Acquisition [Line Items]      
Goodwill $ 6,868,377 $ 6,787,635 $ 6,841,960
Dialysis and other businesses      
Business Acquisition [Line Items]      
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)    
Total assets acquired and liabilities assumed $ 140,535