Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2025	Dec. 31, 2024	Dec. 31, 2023
Revenue Recognition
Other revenues	$ 635,883	$ 555,175	$ 565,206
Total revenues	$ 13,643,069	$ 12,815,550	12,140,147
Accounts Receivable
Revenue Recognition
Percentage Of Accounts Receivable Six Months Or More Past Due	18.00%	23.00%
Intersegment Elimination
Revenue Recognition
Total revenues	$ (72,161)	$ (85,657)	(96,074)
Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,740,392	6,374,882	6,100,183
Other revenues	507,613	463,731	460,991
Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	871,695	863,947	833,744
Other revenues	2	740	1,733
Other Government Payors
Revenue Recognition
Patient service revenues	1,264,038	1,061,440	854,441
Commercial Payors
Revenue Recognition
Patient service revenues	4,192,019	4,031,853	3,874,795
Other revenues	15,399	21,396	32,329
Other
Revenue Recognition
Other revenues	124,072	83,218	78,005
U S Dialysis
Revenue Recognition
Total revenues	11,731,986	11,318,970	10,848,776
U S Dialysis \| Intersegment Elimination
Revenue Recognition
Total revenues	(60,958)	(71,747)	(88,222)
U S Dialysis \| Medicare and Medicare Advantage
Revenue Recognition
Patient service revenues	6,740,392	6,374,882	6,100,183
U S Dialysis \| Medicaid and Managed Medicaid
Revenue Recognition
Patient service revenues	871,695	863,947	833,744
U S Dialysis \| Other Government Payors
Revenue Recognition
Patient service revenues	349,651	343,705	354,304
U S Dialysis \| Commercial Payors
Revenue Recognition
Patient service revenues	3,806,596	3,783,827	3,623,516
U S Dialysis \| Other
Revenue Recognition
Other revenues	24,610	24,356	25,251
Other - Ancillary services
Revenue Recognition
Total revenues	1,911,083	1,496,580	1,291,371
Other - Ancillary services \| Intersegment Elimination
Revenue Recognition
Total revenues	(11,203)	(13,910)	(7,852)
Other - Ancillary services \| Medicare and Medicare Advantage
Revenue Recognition
Other revenues	507,613	463,731	460,991
Other - Ancillary services \| Medicaid and Managed Medicaid
Revenue Recognition
Other revenues	2	740	1,733
Other - Ancillary services \| Other Government Payors
Revenue Recognition
Patient service revenues	914,387	717,735	500,137
Other - Ancillary services \| Commercial Payors
Revenue Recognition
Patient service revenues	385,423	248,026	251,279
Other revenues	15,399	21,396	32,329
Other - Ancillary services \| Other
Revenue Recognition
Other revenues	$ 99,462	$ 58,862	$ 52,754