BACKGROUND: The relationship between heart rate variability (HRV) and residual renal function (RRF) has not been elucidated previously. METHODS: In this cross-sectional study, HRV was evaluated in 71 peritoneal dialysis patients. Patients were divided into RRF decline group, RRF stable group and anuric group. RESULTS: RRF was negatively correlated with SDNN (r = -0.284, p = 0.017), TP (r = -0.247, p = 0.039), and HF (r = -0.238, p = 0.047). Significant sympathetic nerve activation was found in the RRF decline group (significantly lower SDNN, SDSD, RMSSD, pNN50, LF, HF, TP and higher LF/HF ratio) as compared to the RRF stable and anuric groups. Besides, significantly parasympathetic activation was found in the anuric group (the lowest LF/HF ratio as compared to the other groups (both p < 0.05). Multivariate stepwise regression analysis showed that the status of RRF was an independent factor associated with HRV parameters. CONCLUSION: This study showed autonomic nervous function in peritoneal dialysis patients was associated with a different status of RRF.