The relation between the kidney and the heart is bidirectional. Patients with chronic kidney disease have an increased cardiovascular risk with a high prevalence of ischemic heart disease, heart failure, stroke, arrhythmias and sudden cardiac death. Similarly, patients with cardiovascular disorders have a high prevalence of chronic kidney disease. This important organ crosstalk amplifies the morbidity and mortality of these patients beyond the traditional cardiovascular risk factors by incorporating CKD-specific factors (inflammation, oxidative stress, fluid overload, anemia, mineral and bone disorders, uremic toxins with significant cardiac and vascular toxicity, vascular smooth muscle cell phenotype change toward osteoblast and promotion of vascular calcification). Nonetheless, there is a significant challenge in adequate implementation of the guideline-directed medical therapy in the cardio-renal patient, especially in those with moderate to advanced chronic kidney disease. Thus, this chapter aims to provide a unified view of the cardiorenal approach in these patients