Theophylline total body clearance was measured in 29 anuric, chronic obstructive pulmonary disease patients with acute or chronic renal failure during a continuous intravenous infusion. They were divided into two groups depending on the absence (group 1, N = 16) or presence (group 2, N = 13) of congestive heart failure and compared to normal renal function control patients with similar disease states. All study and control patients smoked cigarettes. The theophylline mean total body clearance values (+/- S.D.) for group 1 were 68.0 +/- 14.5, 64.5 +/- 12.9, and 62.6 +/- 17.3 ml/kg.hr for acute renal failure patients, uremic chronic renal failure patients, and control patients, respectively. For group 2, the corresponding values were 25.6 +/- 5.1, 28.6 +/- 8.7, and 27.4 +/- 12.9 ml/kg.hr. There was no significant difference between study and control patients in either group 1 or group 2 (P greater than 0.05, one-way analysis of variance). Since total body clearance determines the steady-state concentration of a drug after repeated administration, theophylline doses do not need to be reduced in acute renal failure or uremia patients.