VIRTUAL REALITY FOR MAINTAINING THE MENTAL HEALTH OF END-STAGE KIDNEY DISEASE PATIENTS: A LITERATURE REVIEW
DOI:
https://doi.org/10.47701/w4mwsq89Keywords:
virtual reality, hemodialysis, anxiety, non- pharmacologicalAbstract
Background: Hemodialysis patients are prone to significant
psychological distress, particularly anxiety related to
routine dialysis procedures and arteriovenous fistula (AVF)
puncture. The high prevalence of anxiety in this population,
ranging from 32% to 76%, underscores the urgent need for
effective therapeutic interventions. Objective: This
systematic literature review aims to analyze the
effectiveness of Virtual Reality (VR) interventions as a non-
pharmacological therapy for reducing anxiety levels in
hemodialysis patients. Methods: This study employed a
systematic literature review design. Seven studies meeting
the inclusion criteria were comprehensively analyzed. These
studies spanned various countries (Egypt, Spain, Iran,
Poland, and Taiwan) and included a total sample of 405
participants. Results: The results of the data synthesis
showed that VR interventions whether in the form of
passive distraction using 360° nature videos or VR-based
physical activities consistently resulted in a significant
reduction in anxiety scores with moderate to large effect
sizes. Conclusion: These findings support the integration of
VR as a safe, effective, and cost-efficient adjunctive
therapeutic modality in the routine care of hemodialysis
patients. VR is a promising technological innovation in the
field of nephrology with great potential to improve patients’
quality of life and psychological well-being. Moving
forward, the development of standardized implementation
protocols and further research are needed so that VR can
become an integral component of patient-centered, holistic
care.
References
Acosta Nuñez, J. M., Acosta Yansapanta, E. A., Tacuri Pérez, S. M., Defaz Defaz, L. M.,
Sangacha Yugsi, A. J., Venegas Mera, B., Chisag Guamán, M. M., Chasillacta
Amores, F. B., Chérrez-Ramírez, A., & Acosta Nuñez, C. H. (2025). Effectiveness
of immersive Virtual Reality in Reducing Anxiety and Pain in Cancer Patients
During Chemotherapy. Metaverse Basic and Applied Research, 4, 197.
https://doi.org/10.56294/mr2025197
Arezoomand, F., Moulaei, K., & Mashoof, E. (2025). Examining the effects of virtual
reality on anxiety and stress reduction in patients undergoing hemodialysis: a pre-
post interventional study. Virtual Reality, 29(4). https://doi.org/10.1007/s10055-
025-01252-8
Barello, S., Anderson, G., Acampora, M., Bosio, C., Guida, E., Irace, V., Guastoni, C. M.,
Bertani, B., & Graffigna, G. (2023). The effect of psychosocial interventions on
depression, anxiety, and quality of life in hemodialysis patients: a systematic review
and a meta-analysis. In International Urology and Nephrology (Vol. 55, Number 4,
pp. 897–912). Springer Science and Business Media B.V.
https://doi.org/10.1007/s11255-022-03374-3
de Brito, D. C. S., Machado, E. L., Reis, I. A., de Freitas do Carmo, L. P., & Cherchiglia,
M. L. (2019). Depression and anxiety among patients undergoing dialysis and kidney
transplantation: A cross-sectional study. Sao Paulo Medical Journal, 137(2), 137–
147. https://doi.org/10.1590/1516-3180.2018.0272280119
de Galvis, S. R., Rodríguez, E. G., Audije-Gil, J., Hernández, S. H., Argilés-Huguet, M.,Botella, A., Villulas, M. B., Casaux-Huertas, A., Sánchez, I. G., López, M. T. M.,
Manso, P., Hernán, D., Dapena, F., & Jiménez, M. D. A. (2025). A Pilot Study of
Virtual Reality in Hemodialysis for Mitigating Pain and Anxiety: User Experiences
and Perceptions. Patient Preference and Adherence , 19, 2069–2079.
https://doi.org/10.2147/PPA.S517622
Durán-Gómez, N., Martín Parrilla, M. Á., Montanero-Fernández, J., López-Jurado, C. F.,
Pérez-Civantos, D., & Cáceres León, M. C. (2025). Impact of mental health status
and clinical factors on health-related quality of life in patients undergoing
haemodialysis: a multicentre cross-sectional study. BMJ Open , 15(10).
https://doi.org/10.1136/bmjopen-2024-097506
Elghoul, S. M., & Younes, O. I. (2025). Impact of virtual reality on pain, anxiety and
depression in pediatric patients with end-stage kidney disease on regular
hemodialysis through arteriovenous fistula: a randomized control double blinded
trial. Alexandria Journal of Pediatrics, 38(1), 109–114.
https://doi.org/10.4103/ajop.ajop_7_25
Elzeky, M. E. H., Salameh, B., Reshia, F. A. A., Sabry, A. A., Shahine, N. F. M., &
Mohamed, E. A. (2024). The effect of virtual reality distraction on haemodialysis
patients’ pain and anxiety during arteriovenous fistula puncture: a randomised
controlled trial. Journal of Research in Nursing, 29(6), 421–434.
https://doi.org/10.1177/17449871241252005
Hoffman, H. G., Meyer, W. J., Drever, S. A., Soltani, M., Atzori, B., Herrero, R., Alhalabi,
W., Richards, T. L., Sharar, S. R., Jensen, M. P., & Patterson, D. R. (2019). Virtual
Reality Distraction to Help Control Acute Pain during Medical Procedures. In A.
“Skip” Rizzo & S. Bouchard (Eds.), Virtual Reality for Psychological and
Neurocognitive Interventions (pp. 195–208). Springer New York.
https://doi.org/10.1007/978-1-4939-9482-3_8
Hsieh, C. H., & Li, D. (2022). Understanding how virtual reality forest experience promote
physiological and psychological health for patients undergoing hemodialysis.
Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1007396
Indovina, P., Barone, D., Gallo, L., Chirico, A., De Pietro, G., & Giordano, A. (2018).
Virtual Reality as a Distraction Intervention to Relieve Pain and Distress During
Medical Procedures: A Comprehensive Literature Review. The Clinical Journal of
Pain, 34(9), 858–877. https://doi.org/10.1097/AJP.0000000000000599
Nagy, E., Tharwat, S., Elsayed, A. M., Shabaka, S. A. E. G., & Nassar, M. K. (2023).
Anxiety and depression in maintenance hemodialysis patients: prevalence and their
effects on health-related quality of life. International Urology and Nephrology,
55(11), 2905–2914. https://doi.org/10.1007/s11255-023-03556-7
Nordgård, R., & Låg, T. (2021). The Effects of Virtual Reality on Procedural Pain and
Anxiety in Pediatrics: A Systematic Review and Meta-Analysis. In Frontiers in
Virtual Reality (Vol. 2). Frontiers Media S.A.
https://doi.org/10.3389/frvir.2021.699383
Rogowski, Ł., Kusztal, M., Kowalska, J., Stefańska, M., Zembroń-Łacny, A., Gołębiowski,
T., & Dziubek, W. (2026). Assessment of Depression and Anxiety in Hemodialysis
Patients Undergoing VR Therapy—Pilot Study. Journal of Clinical Medicine, 15(4).
https://doi.org/10.3390/jcm15041489
Smith, K. L., Wang, Y., & Colloca, L. (2022). Impact of Virtual Reality Technology on
Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-
Analysis. In Frontiers in Virtual Reality (Vol. 2). Frontiers Media S.A.
https://doi.org/10.3389/frvir.2021.751735
Spiegel, B., Fuller, G., Lopez, M., Dupuy, T., Noah, B., Howard, A., Albert, M., Tashjian, V., Lam, R., Ahn, J., Dailey, F., Rosen, B. T., Vrahas, M., Little, M., Garlich, J.,
Dzubur, E., IsHak, W., & Danovitch, I. (2019). Virtual reality for management of
pain in hospitalized patients: A randomized comparative effectiveness trial. PLoS
ONE, 14(8). https://doi.org/10.1371/journal.pone.0219115
Theofilou, P., Togas, C., Vasilopoulou, C., Minos, C., Zyga, S., & Tzitzikos, G. (2015).
The impact of Kt/V urea-based dialysis adequacy on quality of life and adherence in
haemodialysis patients: a cross-sectional study in Greece. Health Psychology
Research, 3(1). https://doi.org/10.4081/hpr.2015.1060
Turoń-Skrzypińska, A., Tomska, N., Mosiejczuk, H., Rył, A., Szylińska, A., Marchelek-
Myśliwiec, M., Ciechanowski, K., Nagay, R., & Rotter, I. (2023). Impact of virtual
reality exercises on anxiety and depression in hemodialysis. Scientific Reports,
13(1), 1–9. https://doi.org/10.1038/s41598-023-39709-y
Ye, W., Wang, L., Wang, Y., Wang, C., & Zeng, J. (2022). Depression and anxiety
symptoms among patients receiving maintenance hemodialysis: a single center
cross-sectional study. BMC Nephrology, 23(1). https://doi.org/10.1186/s12882-022-
03051-8
