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Dosage adjustment in patients with renal impairment is necessary primarily to prevent toxicity due to the decreased excretion of the drug. In individuals with compromised kidney function, the clearance of many medications is significantly reduced, leading to an accumulation of the drug in the body. This accumulation can result in higher plasma concentrations than intended, increasing the risk of adverse effects and toxic reactions.

In the case of renal impairment, the body is less able to eliminate drugs that are normally processed and cleared by the kidneys. Therefore, it becomes critical to adjust the dosage — either by reducing the dose or extending the interval between doses — to ensure that drug levels remain within a therapeutic range that is safe and effective.

While increasing the efficacy of the medication, enhancing absorption, and maintaining patient comfort might be important considerations in medication management, they do not specifically address the core issue of drug clearance and potential toxicity stemming from renal impairment. The primary goal in adjusting dosages for these patients focuses on safety and preventing harm from drug accumulation.