Factors Influencing Stress Perception among Hemodialysis Patients: A Systematic Review


Biopsychosocial model
hemodialysis patients
systematic review


How to Cite

Gunarathne , T. G. N. S., L Abdullah, K., Yoong, T. L., Nanayakkara, N. ., Kun, L. S., & Mohajer, S. (2022). Factors Influencing Stress Perception among Hemodialysis Patients: A Systematic Review. Iranian Red Crescent Medical Journal, 24(6). Retrieved from https://www.ircmj.org/index.php/IRCMJ/article/view/2074


Background: Stress is a common comorbid disorders among hemodialysis patients and diverse factors contributed for stress perception among hemodialysis patients. Although, many findings have been consistent across the literature, there has been a surprising lack of consensus in which factor is most influence the stress perception.

Objectives: This systematic review aimed to provide executive review on factors contribute for stress perception among hemodialysis patients

Methods: Systematic review was conducted in Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, EBESCOhost, Google scholar, Medline and Web of Science (WOS) databases. Rigorous search narrowed to 16 observational studies (Total N=3567) on factors determine for stress perception among hemodialysis patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline were inco-operated. Selected 16 articles were used in the qualitative synthesis.

Results: Stressors were clustered as Biological, Psychological/Behavioral, or Social/Environmental factors. Effect of socio-demographic factors on stress perception was scarce and inconsistent; whilst fatigue and itching were distressing biological factors. Limitations on time and place on vacation, limitation of food and fluid, decrease in social life with substantial economic burden were enlightened as psychological and social stressors respectively.

Conclusion: Multidisciplinary factors were inspired for stress perception among hemodialysis patients. Nursing care plans should addressed holistic nature of stress with appropriate nursing interventions. Although this review adopted the strict selection criteria, it remains difficult to conclude determinants due to methodological drawbacks. Thus, future research in this scope is highly appreciated with prospective longitudinal nature to produce solid clinical conclusions.



Picariello F, Moss-Morris R, Macdougall IC, Chilcot J. The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review. Clinical kidney journal.2017; 10(1): 79-88.

Selye H. The evolution of the stress concept: Stress and cardiovascular disease. The American journal of cardiology. 1970; 26(3): 289-299.

Holmes TH, Rahe RH. The Social Readjustment Rating Scale. Journal of Psychosomatic Research. 1967; 11(2): 213–218.

Suls J and Rothman A. Evolution of the biopsychosocial model: prospects and challenges for health psychology. Health psychology.2004; 23(2): 119.

Engel GL. The need for a new medical model: a challenge for biomedicine. Science.1977; 196(4286): 129-136.

Cukor D, Cohen SD, Peterson RA, Kimmel PL. Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology. 2007; 18(12): 3042-3055.

Rojas JN. Stress and Coping Mechanisms among Hemodialysis Patients in the Gulf and Neighboring Countries: A Systematic Review. International Journal of Advancements in Research and Technology. 2017; 6(4): 36-40.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-9.

Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon MP, Griffiths F, Nicolau B, O’Cathain A, Rousseau MC. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information. 2018; 34(4):285-91.

Shinde M, Mane SP. Stressors and the coping strategies among patients undergoing hemodialysis. International Journal of Science and Research (IJSR). 2014; 3(2):266-76.

Bukhary FE, Sayied NE, Abo-El-Magd MH, Saber EH. Psychological Stress and Coping strategies among chronic hemodialysis patients at el-Minia University Hospital. AAMJ. 2013;11(3):1-48.

Tchape OD, Tchapoga YB, Atuhaire C, Priebe G, Cumber SN. Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon. The Pan African Medical Journal. 2018: 30.

Ahmad MM, Al Nazly EK. Hemodialysis: Stressors and coping strategies. Psychology, health & medicine. 2015; 20(4):477-87.

Cormier-Daigle M, Stewart M. Support and coping of male hemodialysis-dependent patients. International Journal of Nursing Studies. 1997; 34(6):420-30.

Cristóvão F. Stress, coping and quality of life among chronic haemodialysis patients. EDTNA‐ERCA Journal. 1999;25(4):36-9.

Ekelund ML, Andersson SI. Elucidating issues stressful for patients in predialysis and dialysis: from symptom to context. Journal of health psychology. 2007;12(1):115-26.

Lok P. Stressors, coping mechanisms and quality of life among dialysis patients in Australia. Journal of advanced nursing. 1996; 23(5):873-81.

Mok E, Tam B. Stressors and coping methods among chronic haemodialysis patients in Hong Kong. Journal of clinical nursing. 2001; 10(4):503-11.

Yeh SC, Huang CH, Chou HC. Relationships among coping, comorbidity and stress in patients having haemodialysis. Journal of Advanced Nursing. 2008; 63(2):166-74.

Cinar S, Barlas GU, Alpar SE. Stressors and coping strategies in hemodialysis patients. Pak J Med Sci. 2009; 25(3):447-52.

Shahrokhi Z, Rayyani M, Sabzevari S, Haghdoost AA. Stressors and Coping strategies of dialysis patients. J Crit Care Nurs. 2014; 6(4):184-93.

Tarachand JS, Lee P. Understanding the Experience of stress on initiation of Haemodialysis: A Phenomenological Study. International Journal of Nursing. 2014;3(1):11-9.

Logan SM, Pelletier‐Hibbert M, Hodgins M. Stressors and coping of in‐hospital haemodialysis patients aged 65 years and over. Journal of advanced nursing. 2006; 56(4):382-91.

Tu HY, Shao JH, Wu FJ, Chen SH, Chuang YH. Stressors and coping strategies of 20–45-year-old hemodialysis patients. Collegian. 2014; 21(3):185-92.

Gorji MA, Mahdavi A, Janati Y, Illayi E, Yazdani J, Setareh J, Panjaki SA, Gorji AM. Physiological and psychosocial stressors among hemodialysis patients in educational hospitals of northern Iran. Indian journal of palliative care. 2013; 19(3):166.

Horigan AE. Fatigue in hemodialysis patients: a review of current knowledge. Journal of pain and symptom management. 2012 Nov 1;44(5):715-24.Artom M, Moss-Morris R, Caskey F, Chilcot J. Fatigue in advanced kidney disease. Kidney international. 2014; 86(3):497-505.

Seo NS, Kang SJ, Kim JH, Kim SJ. Relationships between fatigue, sleep disturbance, stress, self-efficacy and depression in hemodialysis patients. Journal of Korean Clinical Nursing Research. 2013;19(2):285-97.

Stewart M. Narrative literature review: sexual dysfunction in the patient on hemodialysis. Nephrology Nursing Journal. 2006; 33(6).

Ebrahimi H, Sadeghi M, Amanpour F, Dadgari A. Influence of nutritional education on hemodialysis patients' knowledge and quality of life. Saudi Journal of Kidney Diseases and Transplantation. 2016; 27(2):250.

Sahaf R, Ilali ES. Uncertainty, the overbearing lived experience of the elderly people undergoing Hemodialysis: a qualitative study. International journal of community based nursing and midwifery. 2017; 5(1):13.

Firoz MN, Shafipour V, Jafari H, Hosseini SH, Charati JY. Sleep quality and depression and their association with other factors in hemodialysis patients. Global journal of health science. 2016; 8(8):121.

Bray SH. Self-Care In-Center Hemodialysis. In Present and Future Therapies for End-stage Renal Disease. 2010: 95-107.

Abram HS. Survival by machine: The psychological stress of chronic hemodialysis. Psychiatry in Medicine. 1970; 1(1):37-51.

Nasiri M, Kheirkhah F, Rahimiyan B, Ahmadzadeh B, Hasannejad H, Mohamad JR. Stressful factors, coping mechanisms and quality of life in hemodialysis patients.2013:119-126.

Moran A, Scott PA, Darbyshire P. Existential boredom: the experience of living on haemodialysis therapy. Medical Humanities. 2009; 35(2):70-5.