Introduction/Objective Patients with chronic renal failure (CRF) undergoing cardiac surgery are believed to have more postoperative complications and significantly higher mortality rate. The aim of the paper was to determine preoperative predictors of exacerbation of CRF and the outcome in patients with CRF submitted to cardiac surgery. Methods A retrospective study included 169 patients hospitalized from 2012 to 2015 (age 67.71 ± 8.46 years, 72.3% male). The analysis included numerous perioperative characteristics. Results Preoperative stage I CRF was present in 62 (37%), stage II in 77 (46%), and stage III-V in 30 (17%) patients. Exacerbation of CRF was registered in 37 (21.9%), and the lethal outcome in 16 (9.5%) patients. Stage II of CRF (odds ratio [OR] 4.76; 95% confidence interval [CI] 1.31-17.28; p = 0.018) and stage III-V of CRF (OR 11.39; 95% CI 2.87-45.14; p = 0.001) were designated as predictors for exacerbation of CRF following cardiac surgery. In patients with CRF stage I and II, multivariate analysis designated previous cerebrovascular insult (OR 3.36; 95% CI 1.04-10.93; p = 0.044) and ejection fraction ≤ 35% (OR 5.35; 95% CI 1.83-15.64; p = 0.02) as predictors for the exacerbation of CRF. The only predictor of postoperative dialysis requirement was higher stage of CRF (OR 5.81; 95% CI 1.22-27.81; p = 0.028). CRF stage III-V was a predictor of lethal outcome (OR 7.64; 95% CI 1.49-39.27; p = 0.015). Conclusion Higher stage of CRF in patients submitted to cardiac surgery is a predictor of exacerbation of renal failure and the lethal outcome.