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Non-pharmacological Interventions Improve Mental Health and Sleep in Maintenance Hemodialysis PatientsNon-drug treatments help patients on dialysis manage mood and sleep issues

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Key Takeaway
Non-pharmacological interventions significantly improve depression, anxiety, and sleep quality in hemodialysis patients.

A meta-analysis of 14 randomized controlled trials evaluated the impact of non-pharmacological interventions on patients undergoing maintenance hemodialysis (MHD). The study specifically targeted three primary outcomes: depression, anxiety, and sleep quality, comparing these interventions against standard care.

Results demonstrated significant improvements across all primary metrics. Depression scores showed a substantial reduction (SMD -0.62), while anxiety levels showed a marked decrease (SMD -0.86). Furthermore, sleep quality improved significantly (SMD -0.94) compared to usual care protocols.

While the evidence for depression is of moderate certainty, the findings for anxiety and sleep quality are of lower certainty due to high heterogeneity. Clinicians should consider these non-pharmacological approaches as viable options to manage psychological distress and sleep disturbances in the dialysis population.

Despite the positive outcomes, the study notes potential publication bias regarding depression data. However, the consistent trend across all three metrics suggests that integrating non-pharmacological therapies into standard care may provide meaningful benefits for patients facing the challenges of chronic renal failure.

How this fits prior evidence

This meta-analysis addresses a gap in managing psychological symptoms in patients receiving maintenance hemodialysis. It complements existing evidence regarding non-pharmacological treatments for mental health, such as acupuncture for anxiety and psychological and behavioral interventions for depression in patients with epilepsy. While this study specifically addresses the hemodialysis population, the findings for anxiety and sleep quality should be interpreted with caution due to low certainty of evidence.

Patients who undergo regular dialysis often face difficult mental health challenges. This study looked at how different non-drug treatments helped these patients manage their daily lives. The researchers looked at many different trials to see if these methods worked better than standard care.

Results showed that these non-drug methods led to a big improvement in feelings of sadness. Patients also reported feeling much less worried and nervous. These changes were clear across many different groups of people who were undergoing the same medical treatments.

Additionally, the study found that these methods helped patients sleep much better at night. While the data for sleep and worry was less certain than the data for sadness, the overall trend was positive. These findings suggest that extra support can be very helpful for patients.

Doctors can use these findings to offer more options to their patients. Instead of only using medicine, they can offer activities or therapies to help patients feel better. This can improve the overall quality of life for those dealing with long-term kidney issues.

What this means for you:
Non-drug treatments significantly improve mood, reduce worry, and help patients on dialysis sleep better.

Common questions

What kind of improvements were found for depression and anxiety?

The study found that non-pharmacological interventions significantly improved symptoms of both depression and anxiety in patients receiving maintenance hemodialysis. While the results for depression were considered moderate in certainty, the findings for anxiety were noted to have a lower level of certainty.

Can these treatments help with sleep quality?

The study showed that non-pharmacological interventions significantly improved sleep quality for patients on maintenance hemodialysis. However, because the evidence for sleep quality was found to have low certainty, these specific results should be interpreted with caution.

Are these treatments safe for dialysis patients?

The study did not report any specific adverse events or safety concerns regarding these non-pharmacological interventions. Because the study did not track side effects, you should consult your doctor to determine the safest options for your specific health needs.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BackgroundPatients receiving maintenance hemodialysis (MHD) experience substantial physical and psychological burdens. Non-pharmacological interventions have been increasingly explored as potential approaches for improving psychological symptoms and sleep quality in this population.ObjectiveTo systematically evaluate the effects of non-pharmacological interventions on depression, anxiety, and sleep quality in patients receiving MHD.MethodsSystematic searches were conducted in PubMed, Embase, CINAHL Complete, Cochrane Library, and Web of Science from January 2000 to February 2026 for English-language randomized controlled trials (RCTs). The Cochrane Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in included trials. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used as effect estimates for continuous outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. Meta-analyses were performed using RevMan 5.4 and R version 4.5.2.ResultFourteen randomized controlled trials were included. Meta-analyses comprised 9 studies (570 participants) for depression, 11 studies (647 participants) for anxiety, and 14 studies (871 participants) for sleep quality. Compared with usual care, non-pharmacological interventions significantly improved depression (SMD = −0.62, 95% CI: −0.87 to −0.37, I2 = 52%), anxiety (SMD = −0.86, 95% CI: −1.23 to −0.49, I2 = 79%), and sleep quality (SMD = −0.94, 95% CI: −1.33 to −0.55, I2 = 87%). Leave-one-out sensitivity analyses did not materially reduce heterogeneity for anxiety or sleep quality. Exploratory subgroup analyses revealed no statistically significant differences in effect estimates according to intervention type or duration (P > 0.05). Potential publication bias was suggested for depression, whereas no statistically significant evidence of publication bias was identified for anxiety or sleep quality. Based on the GRADE framework, the certainty of evidence was moderate for depression and low for anxiety and sleep quality.ConclusionThe available evidence suggests that non-pharmacological interventions may improve depressive symptoms, anxiety symptoms, and sleep quality in patients receiving MHD. However, the certainty of evidence was low for anxiety and sleep quality outcomes and moderate for depressive symptoms, and these findings should be interpreted cautiously.Systematic Review RegistrationIdentifier CRD420261370746.
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