v3.26.1
Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2026
Jun. 30, 2025
Jun. 30, 2026
Jun. 30, 2025
Dec. 31, 2025
Disaggregation of Revenue [Line Items]          
Other revenues $ 187,707 $ 172,655 $ 330,458 $ 293,191  
Total revenues 3,554,084 3,379,526 6,969,632 6,603,055  
Contract with Customer, Performance Obligation Satisfied in Previous Period     98,491 95,911  
Contract assets and other receivables 565,566   565,566   $ 494,414
IKC and Medicare          
Disaggregation of Revenue [Line Items]          
Contract assets and other receivables 399,165   399,165   $ 310,541
Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (14,448) (19,552) (38,208) (34,015)  
Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,749,289 1,659,607 3,424,703 3,268,625  
Other revenues 151,824 140,149 260,331 239,103  
Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 226,944 217,699 439,773 424,208  
Other revenues 0 0 0 2  
Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 325,225 308,041 666,344 595,151  
Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,076,280 1,038,240 2,140,187 2,050,330  
Other revenues 6,241 8,322 9,889 11,023  
Other          
Disaggregation of Revenue [Line Items]          
Other revenues 32,729 27,020 66,613 48,628  
U. S. Dialysis And Related Lab Services          
Disaggregation of Revenue [Line Items]          
Total revenues 3,000,462 2,896,675 5,921,692 5,708,110  
U. S. Dialysis And Related Lab Services | Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (11,361) (16,716) (31,833) (28,450)  
U. S. Dialysis And Related Lab Services | Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,749,289 1,659,607 3,424,703 3,268,625  
U. S. Dialysis And Related Lab Services | Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 226,944 217,699 439,773 424,208  
U. S. Dialysis And Related Lab Services | Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 88,848 83,104 181,788 159,850  
U. S. Dialysis And Related Lab Services | Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 940,228 947,015 1,894,471 1,871,903  
U. S. Dialysis And Related Lab Services | Other          
Disaggregation of Revenue [Line Items]          
Other revenues 6,514 5,966 12,790 11,974  
Other Operating Segment          
Disaggregation of Revenue [Line Items]          
Total revenues 553,622 482,851 1,047,940 894,945  
Other Operating Segment | Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (3,087) (2,836) (6,375) (5,565)  
Other Operating Segment | Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Other revenues 151,824 140,149 260,331 239,103  
Other Operating Segment | Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Other revenues 0 0 0 2  
Other Operating Segment | Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 236,377 224,937 484,556 435,301  
Other Operating Segment | Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 136,052 91,225 245,716 178,427  
Other revenues 6,241 8,322 9,889 11,023  
Other Operating Segment | Other          
Disaggregation of Revenue [Line Items]          
Other revenues $ 26,215 $ 21,054 $ 53,823 $ 36,654