The review, conducted by Liqian Bao of Zhejiang University and Kechen Xu of Zhejiang Normal University, followed the Arksey and O’Malley methodological framework and the PRISMA-ScR reporting guidelines. The researchers searched seven electronic databases, including PubMed, Scopus, ProQuest, CINAHL Plus, APA PsycINFO, Ovid MEDLINE, and Web of Science, covering publications from January 2000 to June 2025. From an initial pool of 231 records, the team removed 114 duplicates and screened the remainder in two independent stages, reaching 38 included studies with an inter-rater reliability of Cohen’s kappa of 0.85, indicating excellent agreement between reviewers. Peer-reviewed theses and dissertations were permitted, but other gray literature was excluded to preserve methodological quality.

The geography and design of the evidence base are striking in their breadth. Fourteen studies came from North America, split evenly between the United States and Canada; three came from Brazil; and 21 came from Asia, spanning Iran, China, Jordan, Turkey, South Korea, India, Indonesia, and Kuwait. All 38 studies used quantitative methods, with 21 employing randomized controlled trial designs, and sample sizes ranged from a single case report to 221 participants. In total, the studies covered 1,060 hemodialysis patients whose average ages ranged from 13 to 75 years, allowing the reviewers to assess applicability across adolescents, middle-aged adults, and older people alike.

Among the 35 studies that actually delivered an intervention, the protocols were notably heterogeneous. Standalone mindfulness interventions accounted for roughly a third of programs, mindfulness-based cognitive therapy, or MBCT, made up about 23 percent, mindfulness-based stress reduction, or MBSR, accounted for 17 percent, and adapted mindfulness practices filled the remaining quarter. Most programs ran for eight weeks, with some lasting five and only a few extending to twelve. The adaptations were creative and sometimes surprising: mandala coloring to ease fatigue and stress, yogic breathing delivered electronically to reduce pain, sleep problems, and thirst, and mindful eating and drinking exercises designed to help patients adhere to strict fluid restrictions. Several studies even delivered mindfulness through virtual reality headsets during dialysis sessions, finding that the immersive format decreased symptom severity without adverse effects such as fatigue, nausea, lightheadedness, or headaches.

The psychological findings form the strongest thread in the evidence. Across the majority of trials, mindfulness participants reported significantly lower stress, anxiety, and depression than controls over time. Higher trait mindfulness was associated with lower psychological distress in cross-sectional analyses, and programs that combined mindfulness with affectionate nursing care enhanced psychological resilience and self-management in elderly patients. MBCT improved self-efficacy and treatment compliance, and during the COVID-19 pandemic, mindfulness practice appeared to dampen coronavirus-related anxiety in dialysis units. Patients themselves described greater awareness of thoughts, greater acceptance of difficult experiences, improved family relationships, and better self-care. Yet the picture is not uniformly positive: one pilot feasibility study of brief single-session meditation found no significant changes in depression or anxiety, likely because its sample of 41 patients was too small to detect effects and the dose of practice too brief, and an acceptance and commitment therapy trial found no difference in spiritual health whether mindfulness plus exercises were added during dialysis or not.

Perhaps most provocatively, the review documents physiological changes that go beyond mood. Patients who practiced meditation showed better control of serum phosphorus and reductions in systolic blood pressure. One randomized trial reported that MBSR produced statistically significant differences in kidney function indicators, including serum creatinine, estimated glomerular filtration rate, blood urea nitrogen, and cystatin C. Another trial found that the mindfulness group outperformed controls on pro-inflammatory biomarkers, specifically tumor necrosis factor-alpha and C-reactive protein. MBSR significantly reduced the severity of restless legs syndrome, a common and distressing complication of dialysis, and mindfulness-based interventions alleviated insomnia and improved sleep quality across multiple studies. Combined mindfulness and progressive muscle relaxation training improved ten dimensions of exercise capacity in dialysis patients with sarcopenia, and a weak but positive correlation emerged between trait mindfulness and compliance with fluid restriction, one of the most behaviorally demanding aspects of dialysis self-management.

The review’s authors situate these results within a broader neuroscientific and clinical literature. Two decades of research, supported by neuroimaging studies identifying the brain networks engaged during meditation, have established mindfulness as a legitimate therapeutic construct rather than a wellness fad. MBSR has matched the anxiety medication escitalopram in a randomized trial for anxiety disorders, and mindfulness programs have shown efficacy in settings ranging from intensive care units to chronic pelvic pain. The hemodialysis findings align with this wider evidence and with earlier systematic reviews confirming that mindfulness-based interventions improve mental health and quality of life in chronic kidney disease, reinforcing models that link psychosocial stress to physical comorbidity in this population. The flexible integration of mindfulness with cognitive, behavioral, positive psychology, and acceptance-based frameworks, and even with emerging technologies such as virtual reality, suggests the construct is highly adaptable to clinical constraints, including the hours patients already spend immobilized in the dialysis chair.

Still, the authors are careful about the limits of their evidence. Because this is a scoping review, its purpose was to map the literature rather than formally appraise study quality, so the robustness of individual findings cannot be certified. The included studies varied enormously in intervention type, delivery format, duration, outcome measures, and patient characteristics, limiting comparability and generalizability. The predominance of positive results raises the possibility of publication or selective reporting bias, and the reliance on a limited number of research groups may narrow the evidence base. Crucially, promising trends do not constitute definitive proof of effectiveness. The reviewers call for large, well-designed randomized controlled trials with extended follow-up, standardized protocols, dual independent data extraction, and attention to understudied groups such as adolescents, elderly patients with multiple comorbidities, and socioeconomically diverse populations.

The practical implications, however, are already tangible. For nephrology nurses, social workers, and psychologists embedded in dialysis units, mindfulness offers a feasible, low-cost, nonpharmacological option for a population whose psychological distress directly affects survival. It can be delivered during dialysis sessions themselves, adapted to nearly any age group, and tailored to target the specific symptoms that computational network analyses have identified as central, from pruritus and fatigue to anxiety and sleep disturbance. Barriers remain, including limited funding and space, the need for provider training, time constraints, and the absence of standardized reimbursement codes. But as artificial intelligence-based predictive models begin to classify individual symptom burdens and new scales measure help-seeking behavior, clinicians may soon be able to prescribe mindfulness with the same personalization they apply to medication. What this review makes clear is that the mind, too, deserves a place in the treatment plan for kidney failure, and that the evidence for bringing it there is no longer anecdotal.

Subject of Research: The role of mindfulness-based interventions in improving mental and physical health outcomes for hemodialysis patients.

Article Title: The Role of Mindfulness in Hemodialysis Patients: A Scoping Review

Article References: Bao, L., & Xu, K. (2026). The Role of Mindfulness in Hemodialysis Patients: A Scoping Review. Mindfulness. https://doi.org/10.1007/s12671-026-02977-6

Image Credits: AI Generated

DOI: 10.1007/s12671-026-02977-6

Keywords: mindfulness, hemodialysis, chronic kidney disease, mental health, quality of life, scoping review, MBSR, MBCT, nonpharmacological intervention, dialysis care, anxiety, depression