Background: Cardiorenal Syndrome (CRS) represents a bidirectional interplay between cardiac and renal dysfunction, where impairment of one organ precipitates or exacerbates dysfunction in the other. It is commonly encountered in heart failure (HF) patients and is associated with poor prognosis. Despite increasing awareness, data on the clinical outcomes and prognostic predictors of CRS in Indian populations remain limited. Objective: To evaluate the prevalence, risk factors, and six-month clinical outcomes of CRS in patients with heart failure admitted to a tertiary care hospital, and to identify predictors of mortality Methods: This prospective observational study included 70 patients with heart failure (≥12 years) admitted to D. Y. Patil Hospital, Navi Mumbai (2023–2024). Patients were classified into CRS and non-CRS groups based on consensus diagnostic criteria. Demographic, clinical, biochemical, and echocardiographic parameters were recorded. Patients were followed for six months to assess survival and rehospitalization. Statistical analyses were performed using SPSS version 26.0, with logistic regression to identify independent mortality predictors. Results: Among 70 HF patients, 48 (68.5%) had CRS. The mean age was 60.53 ± 15.55 years, with a male predominance (62.5%). The most common comorbidities were hypertension (63.9%) and diabetes mellitus (50%). Type I CRS was the most frequent subtype (54.1%). Six-month mortality was significantly higher in CRS patients (29.2%) compared to non-CRS patients (0%) (p 2000 pg/mL) (OR 3.8, p=0.008), reduced LVEF (2 mg/dL (OR 2.5, p=0.046), and eGFR Conclusion: CRS was highly prevalent among heart failure patients and strongly associated with increased mortality and poor outcomes. Reduced ejection fraction, elevated NT-proBNP, and renal dysfunction were key predictors of death. Early detection, vigilant monitoring of renal and cardiac function, and timely interventions are vital to improving prognosis in this high-risk group.