Objective To investigate the clinical efficacy of tolvaptan in patient who have acute congestive heart failure (ACHF) complicated with chronic kidney disease (CKD). Method A total of 98 patients in the Cardiovascular Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, were enrolled. They were divided into the tolvaptan group (47 cases) and the control group (51 cases) according to whether or not to take tolvaptan. The tolvaptan was treated with tolvaptan additionally at a dose of 7.5 to 15?mg/day, once daily, compared with the control group. The cardiac function, renal function, electrolytes and other indicators were used to be compared between the two groups, before the treatment and 1 week, 1 month after the treatment. Renal function worsening was assessed in both groups. Result After 1 week and 1 month of treatment, there were differences in NT-proBNP levels between the two groups at different time points (P??0.05). There was a difference in the changes in serum sodium levels between the two groups over time (P??0.05); the changes in BUN, Scr, GFR, β2 microglobulin, and cystatin C levels over time between the two groups were different (P?