Abstract: AIM:To explore and compare the efficacy and safety of enteral nutrition (EN), parenteral nutrition (PN), and EN+PN in treatment of elderly patients of heart failure complicated with renal insufficiency. METHODS: A total of 86 patients with refractory heart failure complicated by renal insufficiency was randomly allocated into three groups: EN+PN (33 cases), EN group (27 cases) and PN group (26 cases). We used a randomized, open, non-placebo-controlled treatment design without long-term follow-up. Clinical efficacy and safety were compared. RESULTS: After treatment, serum albumin (ALB), pre-albumin (PAB), transferrin (TF) and amino terminal B-type natriuretic peptide precursor (NT-proBNP) decreased significantly (P<0.05). Compared with those in EN group and PN group, the decrease of ALB, PAB, TF and NT-proBNP in EN+PN group was significant (P<0.05). After treatment, no significant differences were found between EN group and PN group. No significant difference was found in creatinine (Cr) before and after treatment in the three groups. Stroke volume (SV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic diameter (LVESD) improved significantly in the three groups (P<0.05), with significant difference between EN+PN group and the other two groups but no significant difference between EN group and PN group. Clinical symptoms improvement and severe adverse event rates were similar in the three groups. CONCLUSION: EN + PN produces much better short-term effects than EN or PN alone for elderly patients with heart failure complicated by renal insufficiency.