Late referral: loss of chance for the patient, loss of money for society

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Abstract
Despite all efforts to alert the medical community about its multiple detrimental consequences, late nephrological referral of renal patients still remains a frequent problem in all countries. Recent studies show that up to 40% of patients suffering from chronic renal insufficiency (CRI) begin renal replacement therapy (RRT) less than 6 months after being referred to a renal unit, without having benefited from early nephrological care in the predialysis period [1–11]. This situation is most unfortunate as substantial advances have been made in the management of CRI patients. Late referred patients do not benefit from such progress, especially from the renoprotective and cardioprotective strategies that constitute the basis of optimal therapy of CRI patients today [12–16].