Objective To analyze the incidence of inappropriate use for renal drugs renally inappropriate medications (RIM) and related influencing factors in elderly inpatients with chronic kidney disease (CKD) in order to provide evidence for rational clinical drug use. Methods The clinical data of 748 elderly patients with CKD hospitalized in a large-scale general hospital from January 2020 to December 2020 were collected and retrospectively analyzed. The occurrence of RIM was evaluated by using pharmaceutical tools such as domestic and foreign drug instructions, expert consensus, medication manuals and Micromedex database. SPSS statistics 22.0 was used for data analysis. Multivariate logistic regression was used to analyze the risk factors of RIM. Results The incidence of RIM was 50.27% (376/748) in the elderly CKD patients, and a total of 739 RIM occurred. The top 5 drug categories of RIM were antimicrobial [46.01% (340/739)], endocrine system drugs [11.77% (87/739)], urinary system drugs [11.50% (85/739)], cardiovascular system drugs [9.88% (73 / 739)] and analgesics [7.31% (54/739)]. The top 3 commonly used drugs were spironolactone [9.47% (70/739)], levofloxacin [9.34% (69/739)], and cefoperazone sodium and sulbactam sodium [7.04% (52/739)]. The main inappropriate drug use was that the dose of relevant drugs was not adjusted when the renal function was declined. Multivariate logistic regression analysis showed that age (75-84 years:OR=1.582,95%CI 1.101-2.272; ≥85 years:OR=3.026,95%CI 1.532-5.978, P<0.001), number of drug varieties (11-25:OR=2.379,95%CI 1.500-3.773, P<0.001; ＞25:OR=13.086,95%CI 6.991-24.496, P<0.001), CKD stage (3b stage:OR=2.183,95%CI 1.348-3.536, P=0.002; 4 stage:OR=4.287, 95%CI 2.485-7.395, P<0.001; 5 stage:OR=4.779,95%CI 2.984-7.654, P<0.001) and Charlson comorbidity index (CCI) ≥5 (OR=2.455,95%CI 1.523-3.957; P<0.001) were independent risk factors for RIM in the CKD patients. Conclusion The incidence of RIM is relatively high in the elderly CKD inpatients. To reduce the occurrence of RIM,the CKD patients ≥75 years old, with number of drug varieties≥11, CKD stage≥3b and CCI≥5 should be paid attention to.