Chronic heart failure (CHF) is an essential medical, economic, and social problem of the 21st century. Acute decompensated heart failure (ADHF) is a common cause of hospitalization and mortality in patients with CHF. The article presents the analysis of frequency, prognostic signifi cance, and features of renal failure onset in ADHF patients, as well as the effects of various groups of drugs used in the treatment of ADHF on the kidney function. Special aspects of administering these drugs are elucidated in the context of deteriorating kidney function.