Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Other revenues	$ 129,023	$ 112,665
Total revenues	3,070,555	2,872,699
Contract with Customer, Performance Obligation Satisfied in Previous Period	19,450	12,821
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(27,210)	(23,415)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,531,497	1,482,767
Other revenues	103,110	93,238
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	210,123	205,776
Other revenues	395	570
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	228,372	203,629
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	996,003	889,909
Other revenues	6,940	1,206
Other
Disaggregation of Revenue [Line Items]
Other revenues	21,325	19,019
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,731,697	2,590,113
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(24,463)	(22,047)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,531,497	1,482,767
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	210,123	205,776
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	82,587	82,044
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	925,831	835,393
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	6,122	6,180
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	338,858	282,586
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(2,747)	(1,368)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	103,110	93,238
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	395	570
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	145,785	121,585
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	70,172	54,516
Other revenues	6,940	1,206
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 15,203	$ 12,839