Kidney disease, both acute kidney injury (AKI) and chronic kidney disease (CKD), affects every organ system in the body. The physiological changes associated with kidney disease profoundly alter the pharmacology of many drugs. Caregivers must assess kidney function and consider how decreased kidney function changes the disposition of drugs and their active or toxic metabolites. Hypertension, diabetes mellitus, and heart disease frequently compound the management of drugs in patients with kidney disease.

The number of patients with AKI and CKD has increased. Advances in the treatment of acute and chronic disease in general have permitted patients to live longer. Many of them develop decreased kidney function over time. Indeed, kidney function decreases with age, and older patients make up the most rapidly growing patient group for which an understanding of drug disposition is important. When chronic kidney failure occurs, age, diabetes mellitus, and coronary artery disease are no longer barriers to renal replacement strategies.

Novel strategies for treating acute and chronic kidney failure contribute to the need for understanding drug removal during extracorporeal therapies. New dialysis membranes and devices, acceptance of intermittent and continuous peritoneal dialysis, and the application of continuous extracorporeal renal replacement therapies require better understanding of drug transport across biological and artificial membranes.