Objective To explore the diagnostic value of echocardiography in cardiac lesions of patients with chronic renal failure (CRF). Methods One hundred patients with CRF admitted to the Third Affiliated Hospital of Soochow University from January 2023 to December 2024 were included in the study group, and another 50 healthy individuals undergoing physical examinations were selected as the control group. All the research subjects underwent echocardiography and renal function tests. The differences in renal function and echocardiographic indicators between the two groups were compared, and the echocardiographic indicators and the detection rate of cardiac lesions in different renal function stages of the study group were analyzed. Results Compared with control group, the study group had notably raised levels of serum creatinine(Scr) and blood urea nitrogen(BUN) (both P＜0.05). The abnormal degrees of ultrasound indicators such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular posterior wall thickness (LVPWT) in the study group were all higher than those in the control group (all P＜0.05). As the CRF stage progresses, the degree of abnormality in the echocardiographic indicators of patients showed a gradually worsening trend, and the detection rate of various types of cardiac lesions was also on the rise (all P＜0.05). Conclusion Echocardiography provides a clear visualization of cardiac structural and functional abnormalities in patients with CRF. Its diagnostic parameters effectively reflect the correlation between the severity of renal impairment and the progression of cardiac lesions, thereby serving as a non-invasive modality for clinical screening of cardiac lesions in patients with CRF.