Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Line Items]
Other revenues	$ 125,620	$ 109,684	$ 254,643	$ 222,349
Total revenues	3,186,722	3,000,369	6,257,277	5,873,068
Contract with Customer, Performance Obligation Satisfied in Previous Period			31,309	23,303
Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(16,748)	(21,769)	(43,959)	(45,184)
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,587,198	1,539,639	3,118,696	3,022,405
Other revenues	97,433	87,236	200,542	180,475
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	214,951	216,014	425,075	421,790
Other revenues	445	396	841	965
Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	256,862	218,489	485,233	422,120
Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,015,016	936,904	2,011,019	1,826,814
Other revenues	10,200	3,619	17,140	4,825
Other
Disaggregation of Revenue [Line Items]
Other revenues	21,365	19,841	42,690	38,858
U.S. dialysis
Disaggregation of Revenue [Line Items]
Total revenues	2,828,085	2,710,254	5,559,782	5,300,365
U.S. dialysis | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(12,925)	(20,361)	(37,389)	(42,410)
U.S. dialysis | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	1,587,198	1,539,639	3,118,696	3,022,405
U.S. dialysis | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	214,951	216,014	425,075	421,790
U.S. dialysis | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	80,338	92,525	162,924	174,570
U.S. dialysis | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	952,625	876,033	1,878,455	1,711,427
U.S. dialysis | Other
Disaggregation of Revenue [Line Items]
Other revenues	5,898	6,404	12,021	12,583
Other—Ancillary services
Disaggregation of Revenue [Line Items]
Total revenues	358,637	290,115	697,495	572,703
Other—Ancillary services | Elimination of intersegment revenues
Disaggregation of Revenue [Line Items]
Total revenues	(3,823)	(1,408)	(6,570)	(2,774)
Other—Ancillary services | Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Other revenues	97,433	87,236	200,542	180,475
Other—Ancillary services | Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Other revenues	445	396	841	965
Other—Ancillary services | Other Government Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	176,524	125,964	322,309	247,550
Other—Ancillary services | Commercial Payors
Disaggregation of Revenue [Line Items]
Dialysis patient service revenues	62,391	60,871	132,564	115,387
Other revenues	10,200	3,619	17,140	4,825
Other—Ancillary services | Other
Disaggregation of Revenue [Line Items]
Other revenues	$ 15,467	$ 13,437	$ 30,669	$ 26,275