Effects of Change upon Retrospective Application for Patient Service Revenue and Provision for Uncollectible Accounts (Detail) (USD $) In Thousands, unless otherwise specified	3 Months Ended								12 Months Ended
	Dec. 31, 2013	Sep. 30, 2013	Jun. 30, 2013	Mar. 31, 2013	Dec. 31, 2012	Sep. 30, 2012	Jun. 30, 2012	Mar. 31, 2012	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Patient service operating revenues	$ 3,063,209	$ 2,999,586	$ 2,871,673	$ 2,829,582	$ 2,477,853	$ 1,945,888	$ 1,913,006	$ 1,849,533	$ 8,307,195	$ 7,351,902	$ 6,470,540
Less: Provision for uncollectible accounts									293,546	235,218	190,234
Net patient service revenues									8,013,649	7,116,684	6,280,306
Capitated revenues									2,987,315	481,336	45,133
Other revenues									763,086	588,260	406,367
Total net revenues									11,764,050	8,186,280	6,731,806
Less: Provision for uncollectible accounts									(293,546)	(235,218)	(190,234)
Discontinued operations											(4,022)
Provision for uncollectible accounts									4,852	4,339	3,309
Dialysis And Related Lab Services
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Patient service operating revenues											6,470,540
Previously Reported
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Patient service operating revenues											6,982,214
Less: Provision for uncollectible accounts											197,565
Less: Provision for uncollectible accounts											$ (197,565)