Chronic liver disease is a risk factor for aminoglycoside nephrotoxicity. We conducted this study to identify the incidence and risk factors associated with it. A total of 45 patients with liver disease and 329 controls were included, with a toxicity incidence of 17.7%, similar to that in controls. Chronic liver disease patients received lower amikacin doses than calculated on the basis of creatinine clearance (498 +/- 1187 vs 611 = 313 mg/day). Serum albumin, both at the beginning of the treatment and at the end was lower in patients who developed toxicity, and bilirubin levels were higher in these patients at the end of the treatment. Apparently, a dose reduction may lessen the risk for amikacin nephrotoxicity in patients with chronic liver disease. We conclude that hypoalbuminemia and hyperbilirubinemia are risk factors in this complication.