Abstract Population growth, urbanization, pollution, and climate change pose urgent water challenges in cities. In this study, the sustainability of integrated water resources management in Ho Chi Minh City (HCMC) was evaluated using the City Blueprint approach. The City Blueprint is a set of 24 dedicated indicators divided over 8 categories (i.e., water security, water quality, drinking water, sanitation, infrastructure, climate robustness, biodiversity and attractiveness, and governance including public participation). The analysis showed that the rapid increase of water use for urban, industrial, and agricultural activities in HCMC has resulted in depletion of groundwater and severe pollution of both groundwater and surface water. Surface water quality, groundwater quality, biodiversity, and the sanitation of domestic and industrial wastewater are matters that need serious improvement. Current and future water supply in HCMC is at risk. HCMC can cope with it, but the 7 governance gaps as described by the Organisation for Economic Co-operation and Development (OECD) are major obstacles for HCMC. Rainwater harvesting, pollution reduction, as well as wastewater reuse are among the practical options. Wastewater reuse could lower the water stress index to 10%. The window to do this is narrow and rapidly closing as a result of the unprecedented urbanization and economic growth of this region. Integr Environ Assess Manag 2016;12:345–352. © 2015 SETAC Key Points We reviewed IWRM in Ho Chi Minh City (HCMC) with the City Blueprint approach. This framework is a good start of the transition process of IWRM in cities. Urbanization, pollution, and climate change pose urgent challenges in HCMC. The study illustrates and confirms recent conclusions on water by the World Economic Forum.