[Plasma binding of drugs in chronic renal failure]

As in many pathological states, changes in the plasma protein binding of drugs are observed in uremia. Renal failure reduces the fraction of many acidic drugs bound to serum albumin. This decreased binding is due to many factors: variations of protein concentrations, structural changes of proteins, competitive displacers in plasma of chronic uremic patients. When the margin between pharmacological and toxic doses is narrow, drug monitoring by measurement of plasma free drug concentrations seems necessary to adjust the dosage regimen in uremic patients.