[Chronic renal insufficiency: refer in time]

Three patients reaching end-stage renal failure were referred to an internist-nephrologist. A 53-year old woman was referred late, with several late complications of chronic renal failure such as secondary hyperparathyroidism and signs of left ventricular hypertrophy. In addition she suffered from complications of a temporary vascular access required for intermittent haemodialysis prior to commencing peritoneal dialysis. A 52-year old man was referred early, resulting in reduced late complications of chronic renal failure and the timely start of peritoneal dialysis. An 84-year old man was referred for optimization of metabolic control and to be informed about the possibilities and consequences of renal replacement therapy, which he subsequently refused. With early consultation or referral to a nephrologist (i.e. when the creatinine clearance is < 30 ml/min) complications associated with chronic renal insufficiency can be identified and treated early, with the intention of preventing or reducing their impact, resulting in reduced morbidity and death, even after starting dialysis treatment.