Sudden cardiac death (SCD) is a major problem in patients with end stage renal disease (ESRD) on haemodialysis (HD) and several risk factors are recognized. A major problem may be the autonomic dysfunction which is observed in more than 50 % of ESRD patients. Autonomic dysfunction, and in particular cardiac autonomic dysfunction, is associated with a high risk of ventricular arrhythmias which may eventually lead to SCD. A non-invasive method for measuring cardiac autonomic function is by assessing heart rate variability (HRV) and this review will focus on HRV in HD patients. ESRD patients have an impaired HRV which may partly explain their high risk of SCD. Some intervention studies in HD patients using HRV as a surrogate parameter have been published and are also discussed in this review.