Pharmacokinetics and Therapeutic Drug Monitoring in Liver and Kidney Disease.

Hepatic and renal dysfunction can substantially alter drug pharmacokinetics. This can lead to unpredictable changes in drug clearance and elimination, which may increase the risk of toxicity or treatment failure. Impacts to metabolism, protein binding, filtration, and nonrenal clearance contribute to the considerable variability in drug disposition across both acute and chronic forms of liver and kidney disease. Further, as pharmacokinetic data in these populations are often limited, standard dosing strategies may not apply. Accordingly, therapeutic drug monitoring plays a critical role in guiding individualized drug therapy in the setting of hepatic and renal dysfunction.