Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disaggregation of Revenue [Line Items]
Other revenues	$ 101,274	$ 105,414
Total revenues	2,817,555	2,820,001
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(22,169)	(31,296)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,464,086	1,480,297
Other revenues	83,596	85,595
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	189,655	187,243
Other revenues	538	300
Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	197,695	187,014
Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	887,004	886,977
Other revenues	1,338	6,034
Other
Disaggregation of Revenue [Line Items]
Other revenues	15,812	17,837
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,552,927	2,562,875
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(22,169)	(27,003)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient service revenues	1,464,086	1,480,297
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient service revenues	189,655	187,243
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	80,800	80,184
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	834,579	835,479
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	5,976	6,675
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	264,628	257,126
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues		(4,293)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	83,596	85,595
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	538	300
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	116,895	106,830
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Patient service revenues	52,425	51,498
Other revenues	1,338	6,034
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 9,836	$ 11,162