The use of antifungal agents in patients with renal insufficiency requires careful consideration of not only the degree of renal insufficiency, but also other factors such as the fungal organism involved, site of infection and antifungal pharmacokinetics. Given the increase in the antifungal armamentarium, it is essential to have a comprehensive understanding of these agents to enable tailored therapy in this unique, but not uncommon patient population. This review will focus on the currently available data on this subject, providing guidelines for the use of antifungals in patients with renal failure.