v3.26.3
Segment reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2026
Jun. 30, 2026
Sep. 30, 2025
Sep. 30, 2026
Sep. 30, 2025
Segment Reporting [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
Operating income (loss) 499,255   505,767 1,560,148 1,482,545
Corporate administrative support (26,280)   (25,565) (72,213) (101,309)
Debt expense (150,016)   (150,557) (445,403) (431,674)
Debt extinguishment and modification costs 0 $ (2,035) (5,150) (2,035) (5,150)
Other income (loss), net 9,468   (41,257) 22,241 (81,657)
Income before income taxes 358,707   308,803 1,134,951 964,064
Patient care costs 2,451,047   2,332,759 7,185,305 6,833,959
General and administrative 408,697   414,373 1,254,069 1,201,268
Depreciation and amortization 165,188   177,490 510,825 528,645
Operating expenses 3,078,871   2,914,460 8,987,610 8,540,737
U. S. Dialysis And Related Lab Services          
Segment Reporting [Line Items]          
Total revenues 3,028,470   2,968,108 8,950,162 8,676,217
Depreciation and amortization 144,360   156,242 445,991 469,923
Other Operating Segment          
Segment Reporting [Line Items]          
Total revenues 549,656   452,119 1,597,596 1,347,065
Depreciation and amortization 20,828   21,249 64,834 58,723
Operating Segments          
Segment Reporting [Line Items]          
Total revenues 3,602,244   3,434,930 10,610,084 10,072,000
Operating income (loss) 525,535   531,332 1,632,361 1,583,854
Operating Segments | U. S. Dialysis And Related Lab Services          
Segment Reporting [Line Items]          
Operating income (loss) 544,179   530,113 1,588,123 1,528,729
Patient care costs 2,053,888   1,981,180 6,027,638 5,823,070
General and administrative 316,178   322,355 966,843 917,124
Segment Reporting, Other Segment Item, Amount (8,127)   (9,850) (24,592) (22,247)
Operating expenses 2,506,299   2,449,927 7,415,880 7,187,870
Operating Segments | Other Operating Segment          
Segment Reporting [Line Items]          
Operating income (loss) (18,644)   1,219 44,238 55,125
Operating Segments | U S Dialysis And Related Lab Services with Intersegment          
Segment Reporting [Line Items]          
Dialysis patient service revenues 3,043,632   2,973,765 8,984,367 8,698,351
Total revenues 3,050,478   2,980,040 9,004,003 8,716,599
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | External Sources          
Segment Reporting [Line Items]          
Dialysis patient service revenues 3,021,624   2,961,833 8,930,526 8,657,969
Other revenues 6,846   6,275 19,636 18,248
Operating Segments | U S Dialysis And Related Lab Services with Intersegment | Intersubsegment Eliminations          
Segment Reporting [Line Items]          
Dialysis patient service revenues 22,008   11,932 53,841 40,382
Operating Segments | Other Operating Segments with Intersegment          
Segment Reporting [Line Items]          
Dialysis patient service revenues 386,642   336,257 1,116,914 949,985
Other revenues 163,014   115,862 480,682 397,080
Total revenues 551,766   454,890 1,606,081 1,355,401
Operating Segments | Other Operating Segments with Intersegment | Intersubsegment Eliminations          
Segment Reporting [Line Items]          
Other revenues 2,110   2,771 8,485 8,336
Intersegment Elimination          
Segment Reporting [Line Items]          
Total revenues (24,118)   (14,703) (62,326) (48,718)
Intersegment Elimination | U. S. Dialysis And Related Lab Services          
Segment Reporting [Line Items]          
Total revenues (22,008)   (11,932) (53,841) (40,382)
Intersegment Elimination | Other Operating Segment          
Segment Reporting [Line Items]          
Total revenues $ (2,110)   $ (2,771) $ (8,485) $ (8,336)