Bidirectional association between heart failure and renal failure is not unique and represents one of the several such associations (renal dysfunction, anemia, skeletal myopathy, liver dysfunction, COPD, diabetes, sleep apnea and inflammation, etc.). There are two principal pathways (1) the elevated central venous pressure (the renal vein congestion and intra-abdominal pressure and (2) the decreased cardiac output (reduced renal perfusion and intrinsic kidney disease). In this chapter the management, pathophysiology, treatment and limitations along with newer therapeutic modalities of CHF and CKD are discussed in detail. Cardiovascular system evolves to maintain the balanced milieu of the heart and kidney and heart failure develops when the system fails usually because of CV disease to regulate this balance. So in managing the jeopardy of HF and CKD, don’t mind kidney, treat heart effectively.