The late referral of diabetic patients with kidney insufficiency to nephrologists has a high human and financial cost: interdisciplinary communication is urgently needed

The "late referral to nephrologist" (LRN) phenomenon has been described rec ently, first in Europe and subsequently in every country where dialysis and transplantation are offered without restriction. Definition of LRN is base d on an arbitrary date of referral which is three months before the first d ialysis session. LRN patients suffer much more morbidities and consequently more hospitalizations, particularly in intensive care units. They have les s access to home and self dialysis, to peritoneal dialysis and to renal tra nsplantation than their "on time" referred counterparts. Even if mortality is more important in late referred patients, the additional cost of LRN phe nomenon is substantial; it has been evaluated from 16 800 to 30 500 [V]CE f or the first year of treatment. Every kind of patients are concerned, including diabetics. Explanation of t he LRN phenomenon is complex and needs a multidisciplinary approach.