Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Revenue Recognition
Other revenues	$ 555,175	$ 565,206	$ 433,430
Total revenue net of intersegment revenue	$ 12,815,550	$ 12,140,147	11,609,894
Accounts Receivable
Revenue Recognition
Percentage Of Accounts Receivable Six Months Or More Past Due	23.00%	19.00%
Intersegment Elimination
Revenue Recognition
Eliminations of intersegment revenues	$ (85,657)	$ (96,074)	(91,241)
Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,374,882	6,100,183	6,041,496
Other revenues	463,731	460,991	345,340
Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	863,947	833,744	759,579
Other revenues	740	1,733	1,546
Other Government Payors
Revenue Recognition
Patient service revenues	1,061,440	854,441	801,912
Commercial Payors
Revenue Recognition
Patient service revenues	4,031,853	3,874,795	3,660,522
Other revenues	21,396	32,329	22,211
Other
Revenue Recognition
Other revenues	83,218	78,005	68,529
U.S. dialysis
Revenue Recognition
Total revenue net of intersegment revenue	11,318,970	10,848,776	10,512,774
U.S. dialysis | Intersegment Elimination
Revenue Recognition
Eliminations of intersegment revenues	(71,747)	(88,222)	(87,035)
U.S. dialysis | Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,374,882	6,100,183	6,041,496
U.S. dialysis | Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	863,947	833,744	759,579
U.S. dialysis | Other Government Payors
Revenue Recognition
Patient service revenues	343,705	354,304	336,991
U.S. dialysis | Commercial Payors
Revenue Recognition
Patient service revenues	3,783,827	3,623,516	3,437,306
U.S. dialysis | Other
Revenue Recognition
Other revenues	24,356	25,251	24,437
Other - Ancillary services
Revenue Recognition
Total revenue net of intersegment revenue	1,496,580	1,291,371	1,097,120
Other - Ancillary services | Intersegment Elimination
Revenue Recognition
Eliminations of intersegment revenues	(13,910)	(7,852)	(4,206)
Other - Ancillary services | Medicare and Medicare Advantage
Revenue Recognition
Other revenues	463,731	460,991	345,340
Other - Ancillary services | Medicaid and Managed Medicaid
Revenue Recognition
Other revenues	740	1,733	1,546
Other - Ancillary services | Other Government Payors
Revenue Recognition
Patient service revenues	717,735	500,137	464,921
Other - Ancillary services | Commercial Payors
Revenue Recognition
Patient service revenues	248,026	251,279	223,216
Other revenues	21,396	32,329	22,211
Other - Ancillary services | Other
Revenue Recognition
Other revenues	$ 58,862	$ 52,754	$ 44,092