Complementary Therapies for Reducing Anxiety in Hemodialysis Patients: A Systematic Review

Mesya Mesya; Sri Mulyati  Rahayu; Erwan  Setiyono

doi:10.55927/ajha.v4i1.14226

Authors

Mesya Mesya Aisyah Pringsewu University
Sri Mulyati Rahayu Bhakti Kencana University
Erwan Setiyono University of Muhammadiyah Jakarta

DOI:

https://doi.org/10.55927/ajha.v4i1.14226

Keywords:

Complementary Therapies, Anxiety, Hemodialysis

Abstract

This study discusses the effectiveness of complementary therapies in reducing anxiety in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Through a systematic review of 32 out of 6,711 articles obtained from various databases (2015–2025), it was found that therapies such as Benson relaxation, lavender aromatherapy, music therapy, acupressure, guided imagery, spiritual interventions (dhikr and reading the Qur'an), as well as technologies like Virtual Reality (VR) and brain stimulation (tDCS), are effective in reducing anxiety. These therapies encompass physical, psychological, spiritual, and technological aspects. Although promising, further research is needed to support their clinical implementation.

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References

Afshar, M. et al. (2018) ‘The Effects of Guided Imagery on State and Trait Anxiety and Sleep Quality Among Patients Receiving Hemodialysis: A Randomized Controlled Trial’, Complementary Therapies in Medicine, 40(1), pp. 37–41.

Agustina, E.N., Meirita, D.N. and Fajria, S.H. (2019) ‘Pengaruh Aromaterapi Peppermint Terhadap Perubahan Tingkat Nyeri Pada Pasien Post Operasi Sectio Caesarea Di RSUD Leuwiliang Kabupaten Bogor’, Jurnal Ilmiah Wijaya, 11(2), pp. 17–25.

Ali, M. et al. (2021) ‘Frequency of Intradialytic Complications in Patients of End-Stage Renal Disease on Maintenance Hemodialysis’, Cureus, 13(1), p. e12641.

Alkhaqani, A.L. (2022) ‘Psychological Impact of Chronic Kidney Disease and Hemodialysis: Narrative Review’, Psychosomatic Medicine Research, 4(2), p. 9.

Amirkhani, M. et al. (2021) ‘The Effect of Resilience Training on Stress, Anxiety, Depression, and Quality of Life of Hemodialysis Patients: A Randomized Controlled Clinical Trial’, Iran J Psychiatry Behav, 15(2), pp. 1-9e104490.

Anggun, M. et al. (2021) ‘the Effect of Dhikr on Anxiety and Depression Level in Hemodialysis Patients At Purwokerto Islamic Hospital’, International Journal of Islamic Medicine, 2(1), pp. 15–25.

Arifiati, R.F. and Wahyuni, E.S. (2020) ‘Peningkatan Sense of Humor untuk Menurunkan Kecemasan pada Lansia’, IJIP : Indonesian Journal of Islamic Psychology, 1(2), pp. 139–169.

Auliya, E.P. and Yudiarso, A. (2023) ‘Medium Effect Size Terapi Musik untuk Menurunkan Kecemasan melalui Musik Klasik, Tradisional dan Relaksasi/Instrumental’, Jurnal Psikologi Perseptual, 8(2), pp. 124–137.

Babamohamadi, H. et al. (2015) ‘The Effect of Holy Qur’an Recitation on Anxiety in Hemodialysis Patients: A Randomized Clinical Trial’, Journal of Religion and Health, 54(5), pp. 1921–1930.

Beizaee, Y. et al. (2018) ‘The Effect of Guided Imagery on Anxiety, Depression and Vital Signs in Patients on Hemodialysis.’, Complementary therapies in clinical practice, 33(11), pp. 184–190.

Bello, A.K. et al. (2024) ‘An Update on The Global Disparities in Kidney Disease Burden and Care Across World Countries And Regions’, The Lancet Global Health, 12(3), pp. e382–e395.

Borzoee, F. et al. (2022) ‘The Effect of Humor on Anxiety in Patients Receiving Hemodialysis: An Open-Label, Randomized Trial’, Nursing and Midwifery Studies, 11(2), pp. 112–117.

Caballero-Gallardo, K., Quintero-Rincón, P. and Olivero-Verbel, J. (2025) ‘Aromatherapy and Essential Oils: Holistic Strategies in Complementary and Alternative Medicine for Integral Wellbeing’, Plants, 14(3), pp. 1–24.

Cahyanti, L. et al. (2023) ‘Terapi Relaksasi Benson Terhadap Penurunan Tingkat Kecemasan Dimasa Pandemi Covid-19’, Jurnal Profesi Keperawatan, 10(2), pp. 125–135.

Campo, S. et al. (2022) ‘Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin’, Journal of Clinical Medicine, 11(13), pp. 1–14.

Carisa, F. and Wahyuni, O.D. (2022) ‘Effect of Progressive Muscle Relaxation on Anxiety Level of Medical Faculty Students in Indonesia’, e-CliniC, 10(2), pp. 250–256.

Ceyhan, Ö. et al. (2017) ‘The use of Complementary and Alternative Medicine by Patients Undergoing Hemodialysis’, Alternative Therapies in Health and Medicine, 23(1), pp. 40–45. Chen, T.K., Knicely, D.H. and Grams, M.E. (2019) ‘Chronic Kidney Disease Diagnosis and Management: A Review’, JAMA, 322(13), pp. 1294–1304.

Dehghanmehr, S. et al. (2020) ‘Comparing the Effect of Acupressure and Foot Reflexology on Anxiety and Depression in Hemodialysis Patients: A Clinical Trial’, Medical - Surgical Nursing Journal, 8(4), p. e100386.

Dehkordi, A.K. et al. (2017) ‘Effects of Aromatherapy Using the Damask Rose Essential Oil on Depression, Anxiety, and Stress in Hemodialysis Patients: A Clinical Trial’, Nephro-Urology Monthly, 9(6), p. e60280.

Delgado-Domínguez, C.J. et al. (2021) ‘Influence of Depression and Anxiety on Hemodialysis Patients: The Value of Multidisciplinary Care’, International Journal of Environmental Research and Public Health, 18(7), p. 3544.

Durmuş, M. and Ekinci, M. (2022) ‘The Effect of Spiritual Care on Anxiety and Depression Level in Patients Receiving Hemodialysis Treatment: a Randomized Controlled Trial.’, Journal of religion and health, 61(3), pp. 2041–2055.

Ebrahimi, Z. and Azizi, Z. (2022) ‘Investigating The Effectiveness Of Transcranial Direct Current Stimulation (tDCS) On The Treatment Of Anxiety Disorder In Chronic Renal Dialysis Patients.’, Journal of Research in Psychopathology, 3(7), pp. 19–25.

El-abdeen, M.I.Z. et al. (2022) ‘Effect of Lavender Oil Inhalation versus Acupressure on Anxiety Level of Geriatric Patients Undergoing Hemodialysis’, Alexandria Scientific Nursing Journal, 24(2), pp. 85–97.

Elendu, C. et al. (2023) ‘Comprehensive Review of Current Management Guidelines of Chronic Kidney Disease’, Medicine (United States), 102(23), p. E33984.

Eltafianti, A.A., Widyastuti and Ridfah, A. (2022) ‘Relaksasi Benson dan Penurunan Kecemasan Pasien Gagal’, Jurnal Psikologi Insight, 6(1), pp. 63–47.

Evans, M. et al. (2022) ‘A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives’, Advances in Therapy, 39(1), pp. 33–43.

Faizal, K.M. and Putri, K.E. (2021) ‘Pengaruh Dukungan Spiritual Terhadap Penurunan Tingkat Kecemasan Pada Pasien Pre Operasi Di Ruang Bedah RSUD Depati Bahrin Kabupaten Bangka’, Malahayati Nursing Journal, 3(1), pp. 19–28.

Francis, A. et al. (2024) ‘Chronic Kidney Disease and the Global Public Health Agenda: an International Consensus’, Nature Reviews Nephrology, 20(7), pp. 473–485.

Gorji, M.A.H., Davanloo, A.A. and Heidarigorji, A.M. (2014) ‘The Efficacy of Relaxation Training on Stress, Anxiety, and Pain Perception in Hemodialysis Patients’, Indian Journal of Nephrology, 24(6), pp. 356–361.

Gulcek, E. and Aylaz, R. (2022) ‘The Effect of Music Therapy on Fatigue and Anxiety Levels in Hemodialysis Patients’, Euroasia Journal of Mathematics, Engineering, Natural & Medical Sciences International Indexed and Refereed, 9(22), pp. 113–123.

Haghi, S., Zadeh, S.M. and Vafayee, M. (2019) ‘The Effect of Music on Fatigue and Anxiety of Patients Undergoing Hemodialysis’, Advances in Nursing and Midwifery, 28(1), pp. 20–25.

Haller, J. et al. (2025) ‘The Effects of Echinacea (EP107TM) on Anxiety: A Comparison of Anxiety Measures in a Randomized, Double Blind, Placebo-Controlled Study’, Pharmaceuticals, 18(2), pp. 1–15.

Hidayah, N. et al. (2021) ‘Effectiveness Music Therapy On Hemodialysis Patients: Scooping Review’, Jurnal Keperawatan Komprehensif, 7(1), pp. 105–114.

Hmwe, N.T.T. et al. (2015) ‘The Effects of Acupressure on Depression, Anxiety and Stress in Patients With Hemodialysis: A Randomized Controlled Trial’, International Journal of Nursing Studies, 52(2), pp. 509–518.

Indonesian Renal Registry (2018) 11th Report Of Indonesian Renal Registry 2018, Indonesian Renal Registry (IRR).

Jager, K.J. et al. (2019) ‘A Single Number For Advocacy and Communication—Worldwide More Than 850 Million Individuals Have Kidney Diseases’, Kidney International, 96(5), pp. 1048–1050.

Ji, C. et al. (2019) ‘Effect of music therapy on anxiety in full-term pregnant women’, Frontiers in Psychiatry, 7(1), pp. 23–28.

Kamila, H.S., Maliya, A. and Kristini, P. (2023) ‘The Effect of Music Therapy on Anxiety in Hemodialysis Patients with Kidney Failure : A case report’, Jurnal Berita Ilmu Keperawatan, 16(1), pp. 143–149.

Kiani, F., Zadeh, M.A.H. and Shahrakipour, M. (2017) ‘The Effect of Benson’s Relaxation Method on Hemodialysis Patients’ Anxiety’, Biomedical Research (India), 28(3), pp. 1075–1080.

Kimmel, P.L. and Cukor, D. (2019) ‘Anxiety Symptoms in Patients Treated With Hemodialysis: Measurement and Meaning’, American Journal of Kidney Diseases, 74(2), pp. 145–147.

Komariah, M. et al. (2021) ‘Literature Review Terkait Manfaat Terapi Akupresur Dalam Mengatasi Berbagai Masalah Kesehatan’, Jurnal Medika Hutama, 2(4), pp. 1223–1230.

Krismiadi, D., Wihastuti, T.A. and Ismail, D.D.S.L. (2023) ‘Differences Between the Effects of The Benson Relaxation Technique and Deep Breath on Anxiety, Sleep Quality, and Fatigue in Hemodialysis Patients’, Jurnal Aisyah : Jurnal Ilmu Kesehatan, 8(2), pp. 101–108.

Kurniasih, E., Kurnia, A. and Istiqomah, L.F. (2021) ‘Pengaruh Terapi Spritual (Islam) Terhadap Penurunan Tingkat Kecemasan Pada Pasien Hemodialisa’, Jurnal Keperawatan Galuh, 3(1), pp. 15–20. Kusnanto, K. et al. (2019) ‘The Comparison of Progressive Muscle Relaxation Frequency on Anxiety, Blood Pressure, and Pulse of Haemodialysis Patients’, Jurnal Ners, 14(1), pp. 69–74.

Lin, S.C. and Cheifetz, A.S. (2018) ‘The Use of Complementary and Alternative Medicine in Patients With Inflammatory Bowel Disease’, Gastroenterology and Hepatology, 14(7), pp. 415–425.

Lok, C.E., Yuo, T. and Lee, T. (2025) ‘Hemodialysis Vascular Access: Core Curriculum 2025’, American Journal of Kidney Diseases, 85(2), pp. 236–252.

Mahalaksmi, A.S. et al. (2024) ‘Profil Pengetahuan dan Efektivitas Penggunaan Aromaterapi untuk Mengurangi Stres pada Masyarakat Usia Produktif’, Jurnal Farmasi Komunitas, 11(1), pp. 95–100.

Mazharulhaq et al. (2023) ‘Prevalence of depression in Patients on Hemodialysis’, International Journal of Health Sciences, 7(s1), pp. 41–48.

Meneklİ, T. and Durmaz, Y.Ç. (2021) ‘Effect of Lavender Aromatherapy on Pruritus, Anxiety, and Sleep Quality of Patients Undergoing Hemodialysis: A Randomized Controlled Trial’, TMR Integrative Nursing, 5(5), pp. 163–169.

Midilli, T.S., Ergin, E. and Yilmaz, H. (2017) ‘The Effects of Listening to Music on Vital Signs and Anxiety in Hemodialysis Patients’, International Journal of Health Sciences & Research, 7(9), pp. 117–125. Mollaoğlu, M. et al. (2024) ‘The Effect of Education and Art Therapy with Telehealth Method on Diet-Fluid Restriction and Anxiety in Hemodialysis Patients During the Covid-19 Pandemic’, Alternative therapies in health and medicine, 30(7), pp. 58–64.

Morais, E.M., Moreira, P.R. and Winkelmann, E.R. (2020) ‘Movie watching during dialysis sessions reduces depression and anxiety and improves quality of life: A randomized clinical trial.’, Complementary therapies in medicine, 52, p. 102488.

Muhith, A. et al. (2024) ‘Application of Benson Relaxation Therapy Combined With Spiritual Therapy To Reduce Anxiety in Chronic Kidney Disease Patients Undergoing Hemodialysis’, Revista de Gestao Social e Ambiental, 18(5), pp. 1–12.

Novianti, I. and Safitri Muchtar, A. (2021) ‘Pengaruh Terapi Akupresur terhadap Tingkat Kecemasan pada Ibu Hamil Trimester III’, Jurnal Bidan Cerdas, 3(3), pp. 110–118.

Nurrohmah, F.I. and Rinaldi, M.R. (2022) ‘Terapi Spiritual Emotional Freedom Technique (Seft) Untuk Menurunkan Kecemasan Pada Lansia’, Jurnal Psikologi TALENTA, 8(1), pp. 17–25.

Otaghi, M. et al. (2016) ‘The Effect of Benson Relaxation Technique On Depression in Patients Undergoing Hemodialysis’, International Journal of Medical Research & Health Sciences, 5(12), pp. 76–83.

Ozen, N. et al. (2023) ‘Effects of Long-term Administration of Inhaled Lavender During Hemodialysis on Patients’ Invasive Pain, Anxiety, and Comfort During Cannulation: A Single-blind Randomized Controlled Trial’, Alternative Therapies in Health and Medicine, 29(2), pp. 6–12.

Qawaqzeh, D.T.A. et al. (2023) ‘Factors Affecting the Levels of Anxiety and Depression Among Patients with End-Stage Renal Disease Undergoing Hemodialysis’, International Urology and Nephrology, 55(11), pp. 2887–2896.

Raharjo, Y. et al. (2022) ‘Dialysis Membranes for Acute Kidney Injury’, Membranes, 12(325), pp. 1–15.

Rahimi, F. et al. (2019) ‘The effect of the eye movement desensitization and reprocessing intervention on anxiety and depression among patients undergoing hemodialysis: A randomized controlled trial’, Perspectives in Psychiatric Care, 55(4), pp. 652–660.

Renata, D. and Satrianta, H. (2020) ‘Eye moving desensitization dan reprocessing untuk mereduksi kecemasan menghadapi Covid-19’, TERAPUTIK: Jurnal Bimbingan dan Konseling, 4(1), pp. 65–73.

Riskesdas (2018) ‘Hasil Utama Riset Kesehatan Dasar Tahun 2018’, in Kementrian Kesehatan Republik Indonesia, pp. 1–200.

Safitri, A. and Tresya, E. (2023) ‘Five Finger Hypnosis to Reduce Anxiety Levels during the Covid-19 Pandemic’, Journal of Complementary Nursing, 2(1), pp. 122–126.

Şahin, S., Tokgöz, B. and Demir, G. (2021) ‘Effect of Lavender Aromatherapy On Arteriovenous Fistula Puncture Pain and the Level of State and Trait Anxiety in Hemodialysis Patients: A Randomized Controlled Trial.’, Pain management nursing : official journal of the American Society of Pain Management Nurses, 22(4), pp. 509–515.

Salsabila, D.D. et al. (2025) ‘The Impact Of Lavender Aromatherapy On Decreased Anxiety In Ckd Patients Undergoing Hemodialysis At Royal Prima Medan General Hospital In 2024’, Ners, 9(2), pp. 2051–2055.

Samfriati, S., Friska, G. and S, L.M.S. (2020) ‘Pengaruh Relaksasi Benson Terhadap Tingkat Kecemasan Penularan Corona Virus Disease 2019 Pada Mahasiswa Ners Tingkat Iii Stikes Santa Elisabeth Medan Tahun 2020’, Elisabeth Health Jurnal, 5(02), pp. 131–138.

Sari, F.M. and Aminah, S. (2023) ‘Effect of Ultra Filtration Rate (UFR) on Blood Sugar in Diabetes Mellitus Patients with Complications of Chronic Rental Failure Undergoing Hemodialysis’, Jurnal Keperawatan Komprehensif, 9(288–294).

Şentürk, A. and Kartin, P.T. (2018) ‘The Effect of Lavender Oil Application Via Inhalation Pathway on Hemodialysis Patients’ Anxiety Level and Sleep Quality’, Holistic Nursing Practice, 32(6), pp. 324–335.

Setyaningrum, N. and Setyawan, A. (2023) ‘Effectiveness of Lavender Aromatherapy on Sleep Quality and Anxiety in Patients Who Undergoing Hemodialysis’, International Journal of Islamic and Complementary Medicine, 4(1), pp. 17–24.

Setyawan, A., Syahruramdhani, S. and Setyaningrum, N. (2022) ‘The Effect of Aromatherapy on Anxiety in Patients Undergoing Hemodialysis during COVID-19 Pandemic’, Jurnal Aisyah : Jurnal Ilmu Kesehatan, 7(S2), pp. 285–290.

Siasari, A. et al. (2020) ‘The Effect of Acupressure at P6 Point on Anxiety and Depression in Hemodialysis Patients’, Complementary Medicine Journal, 10(2), pp. 174–183.

Simanjuntak, E. et al. (2023) ‘Pengaruh Aroma Terapi Lavender terhadap Penurunan Tingkat Kecemasan pada Pasien Gagal Ginjal Kronik Sebelum Menjalani Hemodialisa di RS Royal Prima’, MAHESA : Malahayati Health Student Journal, 3(3), pp. 691–699.

Soliva, M.S. et al. (2024) ‘The Effectiveness of Live Music in Reducing Anxiety and Depression Among Patients Undergoing Haemodialysis. A Randomised Controlled Pilot Study’, PLoS ONE, 19(8), pp. 1–15.

Sriulina, L., Widani, N.L. and Hastono, S.P. (2024) ‘The Effect of Pranayama Yoga and Education on Anxiety and Fatigue in Hemodialysis Patients at X Hospital in West Java’, Enrichment, 2(3), pp. 1–10.

Suandika, M. et al. (2021) ‘The Effect of Acupressure on Anxiety and Depression Patients With ESRD Who are Undergoing Hemodialysis’, Atlantis Press, 34(Ahms 2020), pp. 85–89.

Sundara, A.K. et al. (2022) ‘Review Article : Aromaterapi Sebagai Terapi Stres Dan Gangguan Kecemasan’, Jurnal Buana Farma, 2(2), pp. 78–84.

Swarnalatha, G. and Kumar, K.S. (2015) ‘A Review on Complications of Post Dialysis Patients’, International Journal of Pharmaceuticals and Health Care Research (IJPHR), 13(1), pp. 37–47.

Turoń-Skrzypińska, A. et al. (2023) ‘Impact of Virtual Reality Exercises on Anxiety and Depression in Hemodialysis’, Scientific Reports, 13(1), pp. 1–9.

Wen, J. et al. (2023) ‘Mental Health and its Influencing Factors of Maintenance Hemodialysis Patients: A Semi-Structured Interview Study’, BMC Psychology, 11(84), pp. 1–11.

Wijaya, Y.A. et al. (2022) ‘Complementary Nursing Concepts’, Universitas Brawijaya, 3(13), pp. 1–25.

Yan, S. et al. (2025) ‘Psychological Intervention for Depression and Anxiety in Hemodialysis Patients: A Meta-Analysis.’, Actas espanolas de psiquiatria, 53(1), pp. 154–164.

Yonata, A. et al. (2022) ‘Factors Affecting Quality of Life in Hemodialysis Patients’, International Journal of General Medicine, 15(7), pp. 7173–7178.

Yulianti, E. and Mulyono, S. (2021) ‘Efektivitas Virtual Reality dalam Menurunkan Tingkat Kecemasan Pre Operatif pada Pasien yang Menjalani Prosedur Anestesi: Literatur Review’, Promotif : Jurnal Kesehatan Masyarakat, 11(2), pp. 196–206.

Yulianto, A.S., Saelan and Fitriana, R.N. (2024) ‘Pengaruh Terapi Humor Dengan Video Dagelan Jawa Terhadap Tingkat Kecemasan Keluarga Di Instalasi Gawat Darurat’, Keperawatan, 16(2), pp. 611–618.

Yuwono, T., Wardani, R. and Prasetyo, J. (2024) ‘Overcoming Anxiety in Hemodialysis Patients with Mindfulness Therapy: Literature Review’, Journal of Applied Nursing and Health, 6(1), pp. 36–42.

Zhu, Y. et al. (2024) ‘The Mechanisms Underlying Acute Myocardial Infarction in Chronic Kidney Disease Patients Undergoing Hemodialysis’, Biomedicine and Pharmacotherapy, 177, p. 117050.