Background:Acute kidney injury (AKI) is a common and serious complication among patients with acute decompensated heart failure (ADHF), significantly impacting prognosis and clinical outcomes. Identifying factors associated with AKI in this population is crucial for early diagnosis, risk stratification, and management.This study aims to assess the prevalence of AKI and identify its associated factors among patients with ADHF in a hospital-based setting.Methods:This cross-sectional study was conducted in a tertiary care hospital; including 90 patients (both genders) aged 45-70 years diagnosed with ADHF. Clinical, biochemical, and hemodynamic parameters were recorded. AKI was diagnosed based on KDIGO criteria. Potential risk factors such as comorbidities, baseline renal function, medication use, and hemodynamic instability were analyzed. Statistical analysis was performed using SPSS version 25.0, with logistic regression employed to determine independent predictors of AKI.Results:The most common clinical comorbidities in ADHF patients were hypertension (75.6%) and diabetes (46.7%). Over half (55.6%) of the patients presented with NYHA Class III-IV heart failure symptoms. Atrial fibrillation was seen in 31.1%, and 38.9% had tachycardia (>100 bpm).The prevalence of AKI among ADHF patients was found to be 42.2%. Factors significantly associated with AKI included Chronic kidney disease (47.4% vs. 11.5%, p=0.001) and anemia (57.9% vs. 26.9%, p=0.003) were significantly more common among patients who developed AKI. Conclusion:AKI is highly prevalent among ADHF patients and is influenced by multiple clinical and biochemical factors. Early recognition and management of these risk factors may improve renal outcomes and overall prognosis in this high-risk population.