Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Other revenues	$ 405,282	$ 524,353	$ 491,773
Total revenues	11,618,797	11,550,604	11,388,479
Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(95,090)	(162,029)	(146,355)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	6,133,235	6,169,226	6,246,636
Other revenues	326,696	419,662	264,538
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	782,430	744,862	669,089
Other revenues	1,321	1,227	606
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	791,641	715,298	681,836
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	3,596,721	3,540,956	3,430,345
Other revenues	15,553	33,246	130,823
Other
Disaggregation of Revenue [Line Items]
Other revenues	66,290	88,156	110,961
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	10,576,167	10,514,649	10,430,581
U.S. dialysis | Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(90,796)	(145,286)	(132,325)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	6,133,235	6,169,226	6,246,636
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	782,430	744,862	669,089
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	328,256	334,714	329,071
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	3,397,697	3,370,562	3,286,089
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	25,345	40,571	32,021
Other - Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	1,042,630	1,035,955	957,898
Other - Ancillary services | Intersegment Elimination
Disaggregation of Revenue [Line Items]
Total revenues	(4,294)	(16,743)	(14,030)
Other - Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	326,696	419,662	264,538
Other - Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	1,321	1,227	606
Other - Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	463,385	380,584	352,765
Other - Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	199,024	170,394	144,256
Other revenues	15,553	33,246	130,823
Other - Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 40,945	$ 47,585	$ 78,940