Much attention has been paid recently to an early or 'healthy' start of chronic dialysis in patients suffering from end-stage renal disease (ESRD). It is hoped that earlier initiation of dialysis will reduce the increased morbidity and mortality that is observed during the early months in patients who are referred too late to the nephrological unit. This report deals with a survey of the referral pattern of patients with ESRD in 14 European centres. Late referral was defined as those patients presenting to the renal unit within 1 month before chronic dialysis was needed. Between 1993 and 1995, 2236 ESRD patients started dialysis in these 14 centres. A total of 583 patients, representing 26%, were late referrals as defined above. A high variability between the individual centres, even within the same country, was observed. More detailed surveys in both Flemish and European centres revealed that late referrals more frequently started on haemodialysis, had significantly greater co-morbidity and mortality in the first year of dialysis and were transplanted less frequently. It can also be deduced from these results that late referral has important economic consequences, leading to increased costs because of longer initial hospitalization times, the lack of choice for the cheaper form of peritoneal dialysis the lower transplantation rates in the late referrals.