Lower doses are recommended for patients with severe liver and kidney disease. Agomelatine is contraindicated in patients with kidney or liver impairment. People in Kerala experience elevated incidence of cancers, liver and kidney diseases. Greater care is recommended in those with poor liver or kidney function. Caution is recommended in those with liver or kidney problems. Hepatic diseases refers to those affecting the liver. Creatine synthesis primarily occurs in the liver and kidneys. This happens in some cell types like liver and kidney. In those with liver or kidney problems, extra care should be taken. Consequently, there is stimulation for more production of thrombopoietin in the liver and kidneys. In those with severe liver disease liver transplantation may be an option. Phenytoin induces metabolizing enzymes in the liver. He was the first to define atherosclerosis and liver cirrhosis. He also suffered from diabetes and liver cancer. Rates of mortality increase with progression of the underlying liver disease.