| Changes in Goodwill by Reportable Segments [Text Block] |
Changes in goodwill by reportable segments were as follows: | | | | | | | | | | | | | | | | | | | U.S. dialysis | | Other - Ancillary services | | Consolidated | | Balance at December 31, 2019 | $ | 6,287,100 | | | $ | 500,535 | | | $ | 6,787,635 | | | Acquisitions | 24,377 | | | 105,680 | | | 130,057 | | | Divestitures | (1,549) | | | (6,744) | | | (8,293) | | | Foreign currency and other adjustments | — | | | 9,710 | | | 9,710 | | | Balance at December 31, 2020 | $ | 6,309,928 | | | $ | 609,181 | | | $ | 6,919,109 | | | Acquisitions | 3,481 | | | 24,842 | | | 28,323 | | | Foreign currency and other adjustments | — | | | (3,767) | | | (3,767) | | | Balance at June 30, 2021 | $ | 6,313,409 | | | $ | 630,256 | | | $ | 6,943,665 | | | | | | | | | Balance at June 30, 2021: | | | | | | | Goodwill | $ | 6,313,409 | | | $ | 762,407 | | | $ | 7,075,816 | | | Accumulated impairment charges | — | | | (132,151) | | | (132,151) | | | $ | 6,313,409 | | | $ | 630,256 | | | $ | 6,943,665 | |
|