v3.26.3
Revenue Recognition Segment Revenue by Payor (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2026
Sep. 30, 2025
Sep. 30, 2026
Sep. 30, 2025
Dec. 31, 2025
Disaggregation of Revenue [Line Items]          
Other revenues $ 169,860 $ 122,137 $ 500,318 $ 415,328  
Total revenues 3,578,126 3,420,227 10,547,758 10,023,282  
Contract with Customer, Performance Obligation Satisfied in Previous Period     137,520 103,741  
Contract assets and other receivables 565,459   565,459   $ 494,414
IKC and Medicare          
Disaggregation of Revenue [Line Items]          
Contract assets and other receivables 386,724   386,724   $ 310,541
Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (24,118) (14,703) (62,326) (48,718)  
Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,756,098 1,715,224 5,180,801 4,983,850  
Other revenues 137,027 85,877 397,776 324,981  
Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 228,173 214,658 667,947 638,865  
Other revenues     0 2  
Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 342,647 324,623 1,008,991 919,774  
Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,103,356 1,055,517 3,243,542 3,105,847  
Other revenues 4,265 3,762 14,153 14,786  
Other          
Disaggregation of Revenue [Line Items]          
Other revenues 30,678 35,269 96,874 83,895  
U. S. Dialysis And Related Lab Services          
Disaggregation of Revenue [Line Items]          
Total revenues 3,028,470 2,968,108 8,950,162 8,676,217  
U. S. Dialysis And Related Lab Services | Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (22,008) (11,932) (53,841) (40,382)  
U. S. Dialysis And Related Lab Services | Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 1,756,098 1,715,224 5,180,801 4,983,850  
U. S. Dialysis And Related Lab Services | Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 228,173 214,658 667,947 638,865  
U. S. Dialysis And Related Lab Services | Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 89,887 86,996 271,675 246,846  
U. S. Dialysis And Related Lab Services | Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 969,474 956,887 2,863,944 2,828,790  
U. S. Dialysis And Related Lab Services | Other          
Disaggregation of Revenue [Line Items]          
Other revenues 6,846 6,275 19,636 18,248  
Other Operating Segment          
Disaggregation of Revenue [Line Items]          
Total revenues 549,656 452,119 1,597,596 1,347,065  
Other Operating Segment | Elimination of intersegment revenues          
Disaggregation of Revenue [Line Items]          
Total revenues (2,110) (2,771) (8,485) (8,336)  
Other Operating Segment | Medicare and Medicare Advantage          
Disaggregation of Revenue [Line Items]          
Other revenues 137,027 85,877 397,776 324,981  
Other Operating Segment | Medicaid and Managed Medicaid          
Disaggregation of Revenue [Line Items]          
Other revenues     0 2  
Other Operating Segment | Other Government Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 252,760 237,627 737,316 672,928  
Other Operating Segment | Commercial Payors          
Disaggregation of Revenue [Line Items]          
Dialysis patient service revenues 133,882 98,630 379,598 277,057  
Other revenues 4,265 3,762 14,153 14,786  
Other Operating Segment | Other          
Disaggregation of Revenue [Line Items]          
Other revenues $ 23,832 $ 28,994 $ 77,238 $ 65,647