Acute right ventricular failure is increasingly seen in the emergency room and intensive care unit. Acute right ventricular failure is associated with high central venous pressure (CVP) and altered liver and kidney enzymes. Several studies suggested that high CVP might markedly reduce renal blood flow by increasing renal backpressure. A strong relationship was observed between CVP and renal blood flow both in the acute and chronic heart failure setting. Likewise, reducing CVP markedly improved renal function. Accordingly, in patients with heart failure, congestion is the major determinant of renal dysfunction. Thus, vasodilators might be best indicated in heart failure patients with predominant signs of congestion. Their effect to reduce CVP might be very beneficial as it may improve renal blood flow.