Cardiorenal syndrome (CRS) represents a systemic process whereby dysfunction in the kidney or heart leads to dysfunction in the other organ. In the setting of acute decompensated heart failure, type 1 CRS, is quite common and the management is predicated on effective decongestion through diuretics and other decongestive strategies. Recently, there has been a growing interest in non-medication and device therapy to facilitate decongestion as alternative medications such as vasopressin antagonists, inotropes and other vasoactive medications have failed to show clinical efficacy. This multi-disciplinary session will cover the approach to managing patients with acute heart failure and type 1 CRS. Discussion will include novel biomarkers, drugs, devices and clinical management strategies to reverse CRS and adequately decongest acute heart failure patients.