Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2025	Mar. 31, 2024
Disaggregation of Revenue [Line Items]
Other revenues	$ 120,536	$ 129,023
Total revenues	3,223,529	3,070,555
Contract with Customer, Performance Obligation Satisfied in Previous Period	28,463	19,450
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(14,462)	(27,210)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,609,018	1,531,497
Other revenues	98,954	103,110
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	206,509	210,123
Other revenues	2	395
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	286,493	228,372
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,012,707	996,003
Other revenues	2,701	6,940
Other
Disaggregation of Revenue [Line Items]
Other revenues	21,607	21,325
U S Dialysis And Related Lab Services [Member]
Disaggregation of Revenue [Line Items]
Total revenues	2,811,435	2,731,697
U S Dialysis And Related Lab Services [Member] | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(11,734)	(24,463)
U S Dialysis And Related Lab Services [Member] | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,609,018	1,531,497
U S Dialysis And Related Lab Services [Member] | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	206,509	210,123
U S Dialysis And Related Lab Services [Member] | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	76,746	82,587
U S Dialysis And Related Lab Services [Member] | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	924,888	925,831
U S Dialysis And Related Lab Services [Member] | Other
Disaggregation of Revenue [Line Items]
Other revenues	6,008	6,122
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	412,094	338,858
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(2,728)	(2,747)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	98,954	103,110
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	2	395
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	209,747	145,785
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	87,819	70,172
Other revenues	2,701	6,940
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 15,599	$ 15,203