Cardiac disease and kidney disease frequently co-exist. In 2018, the ASIAN-HF registry, a prospective cohort study with patients from 11 Asian regions  (Hong Kong, Taiwan, China, Japan, Korea, India, Malaysia, Thailand, Singapore, Indonesia and Philippines) reported that Chronic Kidney Disease (CKD) was a co-morbidity in 45.4% of patients with chronic heart failure (CHF).1 In the United States, data from the Acute Decompensated Heart Failure National Registry (ADHERE), showed that more than 60% of 118,465 patients admitted to U.S. hospitals with acute decompensated HF (ADHF) had eGFR less than  60 mL/min/1.73 m2.2   The coexistence of cardiac and kidney disease increases the complexity of care for these patients. Clinicians managing CKD patients with HF may often face several dilemmas which  include the following : 1.  Paucity of data for CKD patients 2.  Worsening renal function that is sometimes associated with treatment for heart failure 3. Limitations in the use of pharmacologic therapy due to hyperkalaemia, hypotension         and/or renal impairment   This talk will focus on these dilemmas as well as the possible approaches to deal with them.   References : 1. Tromp J, et al. Multimorbidity in patients with heart failure from 11 Asian regions : A prospective cohort study using the ASIAN-HF registry. PloS Med 15(3):e1002541. https://doi.org/10.1371/journal.pmed.1002541 2. ADHERE ref: Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J, et al. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 2007;13:422e30.