It serves as the outflow of Lake Waikaremoana, flowing southeast from the lake's southeastern shore to reach the Waiau River 20 kilometres (12 mi) northwest of Wairoa.

State Highway 38 follows the river's course for much of its length.

On May 15, 2022, an emergency beacon was activated due to an incident involving a kayaker on the Waikaretāheke River.

Emergency officials arrived too late to the scene, and the kayaker's deceased body was recovered from the river.

This article about a river in the Hawke's Bay Region is a stub.