Objective: To evaluate clinical curative effect and safety of recombinant human brain natriuretic peptide (??rhBNP) combined with levosimendan and continuous renal replacement therapy?? (CRRT) in the treatment of acute decompensated heart failure?? (ADHF). Methods: In the randomized controlled trial, 70 patients with ADHF were enrolled and randomly divided into experimental group (n=35, rhBNP combined with levosimendan and CRRT) and control group (n=35, routine vasodilators combined with CRRT) between January 2022 and January 2025. Differences in therapeutic response, cardiac function, hemodynamic stability, renal performance, and safety were evaluated in both groups. Results: Patients in the experimental group achieved better treatment outcomes than those in the control group. (97.14% vs 80.00%, P<0.05). Treatment led to a rise in left ventricular ejection fraction, B-type natriuretic peptide and left ventricular end-diastolic diameter were lower in experimental group (P<0.05). The pulmonary capillary wedge pressure and mean pulmonary artery depression were lower, and cardiac output was higher in experimental group (P<0.05). The level of serum creatinine was lower, estimated glomerular filtration rate and 24h urine volume were higher in experimental group (P<0.05). The treatment groups exhibited equivalent safety profiles in terms of adverse reactions (P>0.05). Conclusion: rhBNP combined with levosimendan and CRRT can effectively improve curative effect, cardiac function, hemodynamics and renal function indexes in patients with ADHF, which has good safety.