Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Dialysis patient service revenues									$ 10,918,421	$ 10,709,981	$ 10,093,670
Provision for uncollectible accounts									(21,715)	(49,587)	(485,364)
Net dialysis patient service revenues									10,896,706	10,660,394	9,608,306
Other revenues									491,773	744,457	1,268,328
Total revenues	$ 2,898,584	$ 2,904,078	$ 2,842,705	$ 2,743,112	$ 2,821,124	$ 2,847,330	$ 2,886,953	$ 2,849,444	11,388,479	11,404,851	10,876,634
Operating income	$ 462,588	378,336	461,886	$ 340,507	$ 387,908	$ 289,038	$ 438,192	$ 410,686	1,643,317	1,525,824	1,812,755
Corporate administrative support									(92,335)	(90,108)	(44,966)
Debt expense									(443,824)	(487,435)	(430,634)
Debt prepayment, refinancing and redemption charges		$ (21,242)	$ (12,160)						(33,402)	0	0
Other income									29,348	10,089	17,665
Income from continuing operations before income taxes									1,195,439	1,048,478	1,399,786
U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues									10,430,581	10,242,999	9,304,889
Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues									957,898	1,161,852	1,571,745
Operating Segments
Segment Reporting Information [Line Items]
Total revenues									11,534,834	11,532,037	10,956,413
Operating income									1,735,652	1,615,932	1,857,721
Operating Segments | U.S. dialysis
Segment Reporting Information [Line Items]
Dialysis patient service revenues									10,552,600	10,366,996	9,822,299
Provision for uncollectible accounts									(21,715)	(50,927)	(481,973)
Net dialysis patient service revenues									10,530,885	10,316,069	9,340,326
Total revenues									10,562,906	10,335,949	9,360,065
Operating income									1,924,826	1,709,721	2,297,198
Operating Segments | U.S. dialysis | External Sources
Segment Reporting Information [Line Items]
Dialysis patient service revenues									10,421,401	10,274,046	9,767,123
Other revenues									30,895	19,880	19,739
Operating Segments | U.S. dialysis | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues									131,199	92,950	55,176
Other revenues									1,126	0	0
Operating Segments | Other - Ancillary services
Segment Reporting Information [Line Items]
Dialysis patient service revenues									497,021	437,275	323,156
Other revenues									460,877	724,577	1,248,589
Total revenues									971,928	1,196,088	1,596,348
Operating income									(189,174)	(93,789)	(439,477)
Operating Segments | Other - Ancillary services | Intersubsegment Eliminations
Segment Reporting Information [Line Items]
Dialysis patient service revenues									14,030	34,236	24,603
Intersegment Elimination
Segment Reporting Information [Line Items]
Total revenues									(146,355)	(127,186)	(79,779)
Intersegment Elimination | U.S. dialysis
Segment Reporting Information [Line Items]
Total revenues									(132,325)	(92,950)	(55,176)
Intersegment Elimination | Other - Ancillary services
Segment Reporting Information [Line Items]
Total revenues									$ (14,030)	$ (34,236)	$ (24,603)