Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									$ 11,039,709	$ 10,918,421	$ 10,709,981
Provision for uncollectible accounts									(13,458)	(21,715)	(49,587)
Dialysis patient service revenues									11,026,251	10,896,706	10,660,394
Other revenues									524,353	491,773	744,457
Total revenues	$ 2,905,322	$ 2,924,066	$ 2,879,979	$ 2,841,237	$ 2,898,584	$ 2,904,078	$ 2,842,705	$ 2,743,112	11,550,604	11,388,479	11,404,851
Operating income	$ 381,671	$ 437,669	$ 409,920	$ 465,376	$ 462,588	$ 378,336	$ 461,886	$ 340,507	1,694,636	1,643,317	1,525,824
Corporate administrative support									(146,707)	(92,335)	(90,108)
Debt expense									(304,111)	(443,824)	(487,435)
Debt prepayment, refinancing and redemption charges									(89,022)	(33,402)	0
Other income									16,759	29,348	10,089
Income (Loss) from Continuing Operations before Equity Method Investments, Income Taxes, Noncontrolling Interest, Total									1,318,262	1,195,439	1,048,478
Segment Reporting Information footnote:
Equity investment (loss) income									26,916	12,679	(4,484)
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues									10,514,649	10,430,581	10,242,999
Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues									1,035,955	957,898	1,161,852
Operating Segments
Segment Reporting Information [Line Items]
Total revenues									11,712,633	11,534,834	11,532,037
Operating income									1,841,343	1,735,652	1,615,932
Operating Segments | U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									10,632,822	10,552,600	10,366,996
Provision for uncollectible accounts									(13,458)	(21,715)	(50,927)
Dialysis patient service revenues									10,619,364	10,530,885	10,316,069
Total revenues									10,659,935	10,562,906	10,335,949
Operating income									1,917,604	1,924,826	1,709,721
Operating Segments | U.S. dialysis | External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									10,488,731	10,421,401	10,274,046
Other revenues									39,376	30,895	19,880
Operating Segments | U.S. dialysis | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									144,091	131,199	92,950
Other revenues									1,195	1,126	0
Operating Segments | Other - Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									550,978	497,021	437,275
Other revenues									484,977	460,877	724,577
Total revenues									1,052,698	971,928	1,196,088
Operating income									(76,261)	(189,174)	(93,789)
Segment Reporting Information footnote:
Equity investment (loss) income									5,866	9,366	24,866
Operating Segments | Other - Ancillary services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues before provision									16,743	14,030	34,236
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues									(162,029)	(146,355)	(127,186)
Intersegment Elimination | U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues									(145,286)	(132,325)	(92,950)
Intersegment Elimination | Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues									$ (16,743)	$ (14,030)	$ (34,236)