By Author
  By Title
  By Keywords

February 2023, Volume 73, Issue 2

Systematic Review

Do spiritual religious coping strategies affect quality of life in patients with chronic kidney disease? A systematic review

Authors: Wiwit Dwi Nurbadriyah  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Nursalam  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Ika Yuni Widyawati  ( STIKes Kepanjen, Malang, Indonesia. )


Objective: To examine the potential positive and negative effects of spirituality and religion on life quality of patients with chronic kidney disease.


Method: The systematic review comprised studies published from 2010 to 2020 on how spiritual and religious coping mechanisms impact the life quality of chronic kidney disease patients. The search was conducted using Google Scholar, PubMed, Scopus, Ebsco, Clinical Key, Wiley and ProQuest databases. The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.


Results: Of the 519 studies initially identified, 10(1.9%) were reviewed in detail. Of them 7(70%) directly mentioned the elements of spiritual/religious coping mechanisms, 2(20%) mentioned the influence of spiritual/religious strategies on life quality through existential factors relating to physical or spiritual wellbeing, and 1(10%) stated that spiritual/religious coping strategies can have positive or negative effects on the life quality of chronic kidney disease patients.


Conclusion: Spiritual or religious coping mechanisms was found to have the potential to improve life quality of chronic kidney disease patients.


Keywords: Chronic kidney disease, Adaptation, Psychological, Renal insufficiency.  (JPMA 73: S-148 [Suppl. 2]; 2023)






An unhealthy lifestyle can lead to unwanted health problems, including chronic kidney disease (CKD). The body’s capacity to maintain metabolic, fluid, and electrolyte balance diminishes due to CKD, resulting in urea accumulation, or uraemia.1 CKD is the failure of the kidney function that progresses slowly and cannot be recovered, leaving the body unable to keep fluid, electrolyte and metabolic balance which causes uraemia.2 Uraemia can poison all organs, including the brain, leading to complex problems and requiring comprehensive nursing. CKD patients require various medical treatments, including haemodialysis (HD), peritoneal dialysis (PD) or haemofiltration, fluid restriction and drugs to prevent serious complications requiring kidney transplantation.

One of the medical procedures for CKD patients is HD therapy3 which may prevent fatality. However, HD does not cure or reverse CKD. CKD patients on HD therapy have to deal with a variety of issues brought on by the failing kidneys. This becomes a physical stressor that has an impact on the patient’s bio, psycho, socio and spiritual components of life.4-6 Patients on HD treatment may have physical weakness, including oedema, muscle weakness, discomfort, nausea and vomiting. Patients who undergo long-term HD therapy often feel depressed due to chronic illness and fear of death. Besides, there are other problems related to their condition, including financial problems, difficulty in maintaining a job, lost sex drive and impotence. In dealing with these conditions, individuals living with CKD adopt various coping processes.7 Coping is a process by which people try to manage the perceived discrepancy between their demands and resources.8 Coping efforts aim at correcting or controlling a problem, but they also help people change their perception of incongruity, tolerance or acceptance of threats or harm, or fleeing or avoiding situations. Coping with stress due to chronic illness is very influential in changing a person’s quality of life (QOL),9 which is a person’s assessment of the life quality, taking into account physical, social and emotional aspects.10

Prior research has looked at how improving QOL can lower morbidity and mortality rates in CKD patients, but literature on the relationship between religious/spiritual coping strategies and QOL is limited.11-13 The current systematic review was planned to examine the potential positive and negative effects of spirituality and religion on QOL of CKD patients.


Material and methods


The systematic review comprised literature search on Google Scholar, PubMed, Scopus, Ebsco, Clinical Key, Wiley and ProQuest databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.14

The studies included were those published in English-language, peer-reviewed journals between 2010 and 2020 with primary focus on religious/spiritual coping strategies in CKD patients, and which allowed free access to both the abstract and the text. Stduies focussing on the caregivers or families of CKD patients were excluded.

Three reviewers independently conducted the search, using key words, like HD, life quality, religious coping strategies, CKD, coping strategies, spiritual coping, etc.

The studies identified were screened and shortlisted for detailed review. The review did not look at the difference in CKD stage and the duration of HD or any other treatment.




Of the 519 studies initially identified, 10(1.9%) were reviewed in detail (Figure).



Of them 7(70%) directly mentioned the elements of spiritual/religious coping mechanisms, 2(20%) mentioned the influence of spiritual/religious strategies on QOL through existential factors relating to physical or spiritual wellbeing, and 1(10%) stated that spiritual/religious coping strategies can have positive or negative effects on QOL of CKD patients.15-24 Spiritual wellbeing had a significant relationship with low suicide rates.18 The existential wellbeing affected QOL, and there was no connection between spirituality and mental health.16,17

Religion specifically was generally not mentioned except in 2(20%) studies which stated that spiritual/religious coping strategies were Islamic approaches15,22 and 1(10%) had sample limited to Protestants and Catholics. Overall, 3(30%) studies had been conducted in Brazil, 3(30%) in North America, 2(20%) in Iran and 1(10%) each in the Philippines and Indonesia. However, 1(33.3%) of the studies conducted in North America used a sample of patients with Asian ethnicity.

In terms of methodology, 5(50%) studies were cross-sectional, 2(20%) were cohorts, 2(20%) used an ethnographic design, and 1(10%) was a semi-experimental pre-post study.

The cross-sectional design resulted in a limitation as it does not deal with evidence of causality, while the findings of studies with ethnographic design are not generalisable to the larger community. A cohort study was unable to explain causality, while another cohort study had limitation related to the selection of the instrument.

The sample size varied greatly as did the duration and stage of CKD as well as that of the treatment (Table).





Almost all the studies reviewed suggested that religious/spiritual coping mechanism had an impact on QOL. However, literature has also shown that religious/spiritual coping is a double-edged strategy that is not always beneficial to CKD patients.20

The current review covered study subjects from several countries with different cultural backgrounds. This is important because spiritual and religious aspects depend on the religion practised and the social culture around a patient. The culture of religiosity in Indonesia is different from that in, say, Brazil or North America. These cultural differences create social environments and social support in different forms.20,25-28

Another important point is that the concepts of spirituality and religiosity varied in the studies reviewed. This determined the use of instruments to measure the patient’s religiosity and spirituality. The difference in the measurement of spiritual and religious aspects provides a different picture of the meaning of religious and spiritual concepts.16,21,29-31

The limitation of the current systematic review is that it was not registered with the International Prospective Register of Systematic Reviews (PROSPERO).32




QOL of CKD patients is affected by spiritual and religious coping mechanisms, indicating that such mechanisms may enhance QOL of such patients. However, differences in beliefs related to spiritual and religious aspects provide a different picture of the meaning of religious and spiritual concepts.


Acknowledgment: We are grateful to all those who gave permission to conduct the review.


Disclaimer: The text was presented at the International Nursing Conference, 2022, held by Universitas Airlangga, Indonesia.


Conflict of Interest: None.


Source of Funding: None.




1.      Hamler TC, Miller VJ, Petrakovitz S. Chronic Kidney Disease and Older African American Adults: How Embodiment Influences Self-Management. Geriatrics (Basel) 2018;3:52. doi: 10.3390/geriatrics 3030052.

2.      Tong A, Sainsbury P, Chadban S, Walker RG, Harris DC, Carter SM, et al. Patients’ experiences and perspectives of living with CKD. Am J Kidney Dis 2009;53:689-700. doi: 10.1053/j.ajkd.2008.10.050.

3.      Comelis Bertolin D. Clinical variables, lifestyle and coping in hemodialysis. Invest Educ Enferm 2016;34:484-91. doi: 10.17533/ udea.iee.v34n3a07.

4.      Cakmak M, Kose I, Zinzircioglu C, Karaman Y, Tekgul ZT, Pektas S, et al. Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia. Braz J Anesthesiol 2018;68:274-9. doi: 10.1016/j.bjan.2018.01.001.

5.      Reynolds N, Mrug S, Wolfe K, Schwebel D, Wallander J. Spiritual coping, psychosocial adjustment, and physical health in youth with chronic illness: a meta-analytic review. Health Psychol Rev 2016;10:226-43. doi: 10.1080/17437199.2016.1159142.

6.      Yücens B, Kotan VO, Özkayar N, Kotan Z, Yüksel R, Bayram Ş, et al. The association between hope, anxiety, depression, coping strategies and perceived social support in patients with chronic kidney disease. The Journal of Psychiatry and Neurological Sciences 2019;32:43-51. DOI: 10.14744/DAJPNS.2019.00006

7.      Hwang HC, Kim HR, Han DH, Hong JS, Jeong SH, Shin JH, et al. Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients. J Korean Med Sci 2018;33:e148. doi: 10.3346/jkms.2018.33.e148.

8.      García Montes JM, Sánchez Elena MJ, Valverde Romera M. The Influence of Coping and Personality Styles on Satisfaction with Life in Patients with Chronic Kidney Disease. Psychol Belg 2020;60:73-85. doi: 10.5334/pb.518.

9.      Valcanti CC, Chaves Ede C, Mesquita AC, Nogueira DA, de Carvalho EC. Religious/spiritual coping in people with chronic kidney disease undergoing hemodialysis. Rev Esc Enferm USP 2012;46:838-45. doi: 10.1590/s0080-62342012000400008.

10.    Straßner C, Frick E, Stotz-Ingenlath G, Buhlinger-Göpfarth N, Szecsenyi J, Krisam J, et al. Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): study protocol for a cluster-randomized trial. Trials 2019;20:364. doi: 10.1186/s13063-019-3435-z.

11.    Burlacu A, Artene B, Nistor I, Buju S, Jugrin D, Mavrichi I, et al. Religiosity, spirituality and quality of life of dialysis patients: a systematic review. Int Urol Nephrol 2019;51:839-50. doi: 10.1007/s11255-019-02129-x.

12.    Gela D, Mengistu D. Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia. Int J Nephrol Renovasc Dis 2018;11:329-36. doi: 10.2147/IJNRD.S184671.

13.    Niihata K, Fukuma S, Akizawa T, Fukuhara S. Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study. PLoS One 2017;12:e0180498. doi: 10.1371/journal.pone.0180498.

14.    PRISMA. Welcome to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) website! [Online] 2021 [Cited 2022 November 07]. Available from URL:

15.    Bayhakki B, Hatthakit U, Thaniwatthananon P. Self-caring in Islamic culture of Muslim persons with ESRD and hemodialysis: an ethnographic study. Enferm Clin 2019;29:38–41. DOI:10.1016/j.enfcli. 2018.11.015

16.    Darvishi A, Otaghi M, Mami S. The Effectiveness of Spiritual Therapy on Spiritual Well-Being, Self-Esteem and Self-Efficacy in Patients on Hemodialysis. J Relig Health 2020;59:277-88. doi: 10.1007/s10943-018-00750-1.

17.    Davison SN, Jhangri GS. The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease. J Pain Symptom Manage 2013;45:170-8. doi: 10.1016/j.jpainsymman.2012.02.019.

18.    Loureiro ACT, de Rezende Coelho MC, Coutinho FB, Borges LH, Lucchetti G. The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis. Compr Psychiatry 2018;80:39-45. doi: 10.1016/j.comppsych.2017.08.004.

19.    Saffari M, Pakpour AH, Naderi MK, Koenig HG, Baldacchino DR, Piper CN. Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis. Nephrolog 2013;18:269-75. doi: 10.1111/nep.12041.

20.    Vitorino LM, Soares RCES, Santos AEO, Lucchetti ALG, Cruz JP, Cortez PJO, et al. Two Sides of the Same Coin: The Positive and Negative Impact of Spiritual Religious Coping on Quality of Life and Depression in Dialysis Patients. J Holist Nurs 2018;36:332-40. doi: 10.1177/0898010117725429.

21.    Cruz JP, Reyes RWP, Colet PC, Estacio JC, Caldeira S, Vitorino LM, et al. Psychometric Evaluation of the Filipino Versions of the Duke University Religion Index and the Spiritual Coping Strategies Scale in Filipino Hemodialysis Patients. J Relig Health 2017;56:1381-96. doi: 10.1007/s10943-016-0355-z.

22.    Pilger C, Santos ROPD, Lentsck MH, Marques S, Kusumota L. Spiritual well-being and quality of life of older adults in hemodialysis. Rev Bras Enferm 2017;70:689-96.doi: 10.1590/0034-7167-2017-0006.

23.    Chatrung C, Sorajjakool S, Amnatsatsue K. Wellness and Religious Coping Among Thai Individuals Living with Chronic Kidney Disease in Southern California. J Relig Health 2015;54:2198-211. doi: 10.1007/s10943-014-9958-4.

24.    Davison SN, Jhangri GS. Existential and religious dimensions of spirituality and their relationship with health-related quality of life in chronic kidney disease. Clin J Am Soc Nephrol 2010;5:1969-76. doi: 10.2215/CJN.01890310.

25.    Knowles S, Swan L, Salzberg M, Castle D, Langham R. Exploring the relationships between health status, illness perceptions, coping strategies and psychological morbidity in a chronic kidney disease cohort. Am J Med Sci 2014;348:271-6. doi: 10.1097/MAJ. 0000000000000242.

26.    Gurkan A, Pakyuz SÇ, Demir T. Stress Coping Strategies in Hemodialysis and Kidney Transplant Patients. Transplant Proc 2015;47:1392-7. doi: 10.1016/j.transproceed.2015.05.022

27.    Santos PR, Capote Júnior JRFG, Cavalcante Filho JRM, Ferreira TP, Dos Santos Filho JNG, da Silva Oliveira S. Religious coping methods predict depression and quality of life among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol 2017;18:197. doi: 10.1186/s12882-017-0619-1

28.    Cruz JP, Colet PC, Alquwez N, Inocian EP, Al-Otaibi RS, Islam SM. Influence of religiosity and spiritual coping on health-related quality of life in Saudi haemodialysis patients. Hemodial Int 2017;21:125-32. doi: 10.1111/hdi.12441.

29.    Cruz JP, Baldacchino DR, Alquwez N. Validity And Reliability Of The Spiritual Coping Strategies Scale Arabic Version In Saudi Patients Undergoing Haemodialysis. J Ren Care 2016;42:107-14. doi: 10.1111/jorc.12155.

30.    Zaman A. Islamic economics: A survey of the literature. Islamic Studies 2010;49:37-63

31.    Vitorino LM, Lopes-Júnior LC, de Oliveira GH, Tenaglia M, Brunheroto A, Cortez PJO,et al. Spiritual and religious coping and depression among family caregivers of pediatric cancer patients in Latin America. Psychooncology 2018;27:1900-7. doi: 10.1002/pon.4739.

32.    Hu H, Ji Z, Feng C, Pang W, Chen Z, Zhang J, et al. PROSPERO’s systematic review protocols of traditional Chinese medicine for COVID-19: An overview. Integr Med Res 2021;10(Suppl):100774. doi: 10.1016/j.imr.2021.100774.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: