Abstract： Objective:To investigate the clinical efficacy and safety of tolvaptan in elderly chronic heart failure patients with renal insufficiency.Methods:This study was a retrospective cohort study, a total of 92 elderly chronic heart failure patients with renal insufficiency in the Third Cardre′s Ward department of the General Hospital of Northern Theater Command from July 2018 to July 2021, including 64 males and 28 females, aged(92.9±5.6)years old, ranging from 85 to 103 years old, they were divided into furrosemide group and toraputan group, with 46 patients in each group.Patients in furosemide group were treated with furosemide and other routine anti-heart failure methods, while patients in torvalptan group were treated with torvalptan in addition to furosemide group, the changes of cardiac, hepatic and renal functions, electrolytes, urine volume, hospitalization time and side effects were compared between the two groups before and 7 days after treatment.The patients were followed up for 3 months to compare the rehospitalization for heart failure between the two groups.Results:After 7 days of treatment, the serum creatinine of furosemide group[(139.5±22.8)μmol/L]was higher than that of before treatment[(131.5±21.5)μmol/L], the serum creatinine of torvastatin group[(122.3±22.0)μmol/L]was lower than that of before treatment[(129.9±26.9)μmol/L], the serum sodium[(139.4±3.4)mmol/L]was higher than that of before treatment[(133.5±3.5)mmol/L], the differences were statistically significant( P<0.05). After 7 days of treatment, serum creatinine was lower and serum sodium was higher in the atorvastatin group than in the furosemide group, the differences were statistically significant( P<0.05). The body mass of the patients in the furosemide group at 7 days after treatment[(62.6±8.5)kg]was lower than before treatment[(64.5±9.2)kg], the body mass of the patients in the torvastatin group at 7 days after treatment[(63.5±8.4)kg]was lower than before treatment[(66.0±9.6)kg], the differences were statistically significant( P<0.05). The urine volume of furosemide group before treatment was(1 277.9±432.8)ml, and the average daily urine volume after 7 days of treatment was(2 131.5±354.2)ml, the urine volume of torvastatin group before treatment was(1 233.4±423.5)ml, after 7 days of treatment, the average daily urine volume was(2 310.5±395.3)ml, the differences were statistically significant( P<0.05). After 7 days of treatment, N-terminal pro-B-type natriuretic peptide(NT-proBNP)in furosemide group[(2 225.4±622.4)g/L]was lower than that before treatment[(3 599.4±718.3)g/L], left ventricular ejection fraction[LVEF, (40.7±3.1)%]was higher than that before treatment[(39.2±3.6)%], the level of NT-proBNP in the torvastatin group[(1 759.5±440.5)g/L]was lower than that before treatment[(3 879.6±776.4)g/L], LVEF[(41.9±2.6)%]was higher than that before treatment[(38.5±3.9)%], the differences were statistically significant( P<0.05). After 7 days of treatment, NT-proBNP was lower and LVEF was higher in the torvastatin group than in the furosemide group, the differences were statistically significant( P<0.05). Conclusions:The treatment of elderly patients with chronic heart failure and renal insufficiency with atorvastatin can effectively reduce fluid load, improve cardiac function, protect renal function, shorten hospital stay, and has a high safety.