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Goodwill (Tables)
 12 Months Ended
Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]  
Changes in Carrying Value of Goodwill by Reportable Segments Changes in the carrying value of goodwill by reportable segments were as follows:
 
U.S. dialysis and
related lab services
 
Other ancillary
services and
strategic initiatives
 
Consolidated total
Balance at December 31, 2016
$
5,691,587

 
$
323,788

 
$
6,015,375

Acquisitions
485,434

 
131,598

 
617,032

Divestitures
(32,260
)
 
(126
)
 
(32,386
)
Impairment charges
—

 
(36,196
)
 
(36,196
)
Foreign currency and other adjustments
—

 
46,454

 
46,454

Balance at December 31, 2017
$
6,144,761

 
$
465,518

 
$
6,610,279

Acquisitions
130,574

 
147,774

 
278,348

Divestitures
(331
)
 
(15,166
)
 
(15,497
)
Impairment charges
—

 
(3,106
)
 
(3,106
)
Foreign currency and other adjustments
—

 
(28,064
)
 
(28,064
)
Balance at December 31, 2018
$
6,275,004

 
$
566,956

 
$
6,841,960

 
 
 
 
 
 
Goodwill
$
6,275,004

 
$
594,229

 
$
6,869,233

Accumulated impairment charges
—

 
(27,273
)
 
(27,273
)
 
$
6,275,004

 
$
566,956

 
$
6,841,960
Schedule of Reporting Units Goodwill Balances Based on the most recent assessments, the Company determined that reductions in reimbursement rates, changes in actual or expected growth rates, or other significant adverse changes in expected future cash flows or valuation assumptions could result in goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment as of December 31, 2018:
Reporting unit
 
Goodwill
balance as of
December 31, 2018
 
Carrying amount
coverage(1)
 
Sensitivities
Operating
income(2)
 
Discount
rate(3)
Germany Kidney Care
 
$
403,200

 
0.5
%
 
(1.5
)%
 
(10.3
)%
Brazil Kidney Care
 
$
39,452

 
9.8
%
 
(2.5
)%
 
(7.3
)%
Germany other health operations
 
$
12,646

 
8.1
%
 
(2.2
)%
 
(11.1
)%
 
 
(1)
Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date.
(2)
Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date.
(3)
Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.