Congestive heart failure, chronic kidney insufficiency and anemia are often present in the same patient. We have coined this triad the cardio-renal anemia syndrome. We suggest that congestive heart failure can often cause chronic renal failure, with both diseases producing anemia. The anemia exacerbates the chronic heart failure, which then worsens the chronic renal failure, causing further anemia, in a vicious cycle. Together with early detection and treatment of the chronic heart failure, correction of the associated anemia with a combination of subcutaneous erythropoietin and intravenous iron will often alleviate the chronic heart failure and slow down or stop the progression of the associated chronic kidney insufficiency.