Main Article Content


Hemodialysis is a therapy given to replace kidney function. This therapy has various physical and psychological impacts on the sufferers. This study aims to analyze stress conditions with fatigue in patients undergoing hemodialysis. Analytic observation research design with a cross-sectional approach. Population of chronic renal failure patients undergoing hemodialysis. The sample was 54 patients, with a non-random sampling technique, with inclusion criteria, namely routine hemodialysis 2 times/week, full consciousness, communication well, and not experiencing complications during dialysis. Analysis using the Independent T-test and Pearson Correlation Test. The instruments used were the Depression Anxiety Stress Scale questionnaire and the fatigue questionnaire. The analysis results obtained the youngest age (17 people), more women than men, most of them have higher education and most of them undergo hemodialysis for more than 11 months. The average patient undergoing hemodialysis experienced mild stress and was in a state of severe fatigue. There was a significant relationship between stress and fatigue (p-value 0.048), with a prediction model that increasing one stress score will increase the fatigue score by 0.237. Therefore, psychological aspects must be an important concern in providing nursing care to patients undergoing hemodialysis in the hemodialysis unit.


Fatigue; Psychological; Stress

Article Details

How to Cite
Sulistini, R., Pratama, Y., Febriani, I., Susanti, E., & Erman, I. (2024). Stressful Conditions Increase Fatigue during Undergoing Hemodialysis. JKEP, 9(1), 109-115.


    Artom, M. et al. (2014) ‘Fatigue in advanced kidney disease’, Kidney International, 86(3), pp. 497–505. doi: 10.1038/ki.2014.86.

    Bezerra, C. I. L., Silva, B. C. and Elias, R. M. (2018) ‘Decision-making process in the pre-dialysis CKD patients: Do anxiety, stress, and depression matter?’, BMC Nephrology, 19(1), pp. 1–6. doi: 10.1186/s12882-018-0896-3.

    Bossola, M. et al. (2023) ‘Fatigue in Patients Receiving Maintenance Hemodialysis: A Review’, American Journal of Kidney Diseases, 82(4), pp. 464–480. doi: 10.1053/j.ajkd.2023.02.008.

    Canaud, B. et al. (2021) ‘Multitargeted interventions to reduce dialysis-induced systemic stress’, Clinical Kidney Journal, 14, pp. I72–I84. doi: 10.1093/ckj/sfab192.

    Diyono and Mulyanti, S. (2019) Keperawatan Medikal Bedah Sistem Urologi. Surakarta: ANDI.

    García-Llana, H. et al. (2014) ‘El papel de la depresión, la ansiedad, el estrés y la adhesión al tratamiento en la calidad de vida relacionada con la salud en pacientes en diálisis: Revisión sistemática de la literatura’, Nefrologia, 34(5), pp. 637–657. doi: 10.3265/Nefrologia.pre2014.Jun.11959.

    Gerogianni, S. K. and Babatsikou, F. P. (2014) ‘Psychological aspects in chronic renal failure’, Health Science Journal, 8(2), pp. 205–214.

    Ghaffari, M. et al. (2019) ‘What are the hemodialysis patients’ styles in coping with stress? A directed content analysis, International Journal of Community Based Nursing and Midwifery, 7(4), pp. 309–318. doi: 10.30476/IJCBNM.2019.81324.0.

    Harrington, R. (2013) Stress, health & well-being : thriving in the 21st century. Belmont, CA : Wadsworth Cengage Learning.

    Indonesian Nephrology Association (2023) Konsensus Gangguan Ginjal Akut. 1st edn, Pernefri. 1st ed. Jakarta. Available at:

    Kang, H. and Chae, Y. (2021) ‘Effects of integrated indirect forest experience on emotion, fatigue, stress and immune function in hemodialysis patients’, International Journal of Environmental Research and Public Health, 18(4), pp. 1–12. doi: 10.3390/ijerph18041701.

    Kocalevent, R. D. et al. (2011) ‘Determinants of fatigue and stress’, BMC Research Notes, 4, pp. 0–4. doi: 10.1186/1756-0500-4-238.

    Loenggogeni, D. P. (2023) Edukasi dan Self Managemen Pasien Hemodialisis. CV.Mitra Edukasi Negeri.

    Muttaqin, D. and Ripa, S. (2021) ‘Psychometric properties of the Indonesian version of the Depression Anxiety Stress Scale: Factor structure, reliability, gender, and age measurement invariance’, Psikohumaniora, 6(1), pp. 61–76. doi: 10.21580/pjpp.v6i1.7815.

    Parvan, K. et al. (2015) ‘Coping methods to stress among patients on hemodialysis and peritoneal dialysis’, Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 26(2), pp. 255–262. doi: 10.4103/1319-2442.152409.

    Perhimpunan Nefrologi Indonesia (2020) 13 th Annual Report of Indonesian Renal Registry 2020. Bandung. Available at:

    Picariello, F. et al. (2017) ‘The role of psychological factors in fatigue among end-stage kidney disease patients: A critical review’, Clinical Kidney Journal, 10(1), pp. 79–88. doi: 10.1093/ckj/sfw113.

    Prastiwi, F., Wihastuti, T. A. and Ismail, D. D. S. L. (2021) ‘Factors Associated with Fatigue in Chronic Kidney Disease Patients Undergoing Hemodialysis: A Systematic Review’, Jurnal Kedokteran Brawijaya, 31(4), pp. 260–268. doi: 10.21776/ub.jkb.2021.031.04.12.

    Sulistni, R., Damanik, H. D. and Lukman (2021) ‘Anxiety Stress and Fatigue in Hemodialysis Patient’, Proceedings of the First International Conference on Health, Social Sciences and Technology (ICoHSST 2020), 521(ICoHSST 2020), pp. 88–91. doi: 10.2991/assehr.k.210415.020.

    Sultan, S. et al. (2023) ‘Managing Mental Health Problems and Quality of Life among Dialysis Patients through Stress Management Intervention’, Fui.Edu.Pk, (January 2022). doi: 10.33897/fujp.v6i1.454.

    Suriani, E., Neherta, M. and Sari, I. M. (2023) Perawatan Holistik dan efektif pada anak dengan Penyakit Kronis Gagal Ginal Kronik. 1st edn. CV adanu Abimata.

    Tennant, K. F. (2019) ‘Assessment of Fatigue in Older Adults : The FACIT Fatigue Scale (Version 4)’, 10(30). doi: 10.1186/1477-7525-10-100.