Liver disease predisposes to aminoglycoside nephrotoxicity but specific features of such disease that may predispose to amikacin-induced renal injury have not been identified. The objective of this study was to identify risk factors associated with it. A retrospective chart review of 90 patients who had received more than three doses of amikacin was conducted; 35 patients with liver disease and 55 controls were included. Patients with liver disease showed more nephrotoxicity than controls based on the creatinine level changes. (0.05±0.09 vs 0.51±0.72, p < 0.05). The initial pre-treatment serum albumin level was lower in the patients who developed amikacin-induced nephrotoxicity (3.19±0.72 vs 2.77±0.61, p < 0.05). The pre-treatment albumin level correlated with the change in creatinine level during amikacin therapy (p < 0.05). Based on the results, it was concluded that amikacin should be avoided in liver disease patients with low serum albumin level.