This paper explores the relationship between area level measures of social disadvantage and the late referral of patients with end-stage renal disease (ESRD) to a nephrologist. Patients who were referred late were those who needed to commence dialysis within 3 months of referral to a nephrologist. Late referral has been associated with increased morbidity and mortality. We studied 3334 patients who started ESRD treatment in Australian capital cities between 1 April 1995 and 31 December 1998. The proportion referred late varied between areas, was higher in areas of greater disadvantage and was significantly related to the age- and sex-standardised incidence of ESRD. This may indicate inequitable access to optimal pre-ESRD care. (C) 2003 Elsevier Science Ltd. All rights reserved.