The Effects of Dhikr Combined with Deep Breathing Exercises on Stress, Anxiety, and Cortisol Levels among Chronic Kidney Disease (CKD) Patients

Authors

  • Mega Wulandari Universitas Nahdlatul Ulama Surabaya
  • Dyah Ika Krisnawati Universitas Nahdlatul Ulama Surabaya
  • Chilyatiz Zahroh Universitas Nahdlatul Ulama Surabaya

DOI:

https://doi.org/10.37287/ijghr.v8i5.2328

Keywords:

anxiety, cortisol, dhikr, nephropaty, respiration, stress

Abstract

Chronic kidney disease is a critical global healthcare challenge frequently exacerbated by psychological distress. Non-pharmacological interventions targeting both psychological and physiological pathways remain poorly understood. Objective: This study evaluated the effects of combining dhikr with deep breathing exercise on stress, anxiety, and cortisol level among chronic kidney disease patients. A randomised controlled trial was conducted at Syarifah Ambami Rato Ebhu Hospital, Bangkalan, involving 34 hospitalised patients equally allocated to an intervention programme (n = 17) or a standard health education control group (n = 17). Data were analysed using the paired t-test, independent t-test, and multivariate analysis of variance. The combined intervention significantly decreased post-test stress (p = 0.001) and anxiety (p = 0.021) relative to the control cohort. Changes in serum cortisol concentration were not statistically significant within or between groups (p = 0.864). However, the omnibus multivariate analysis demonstrated a highly significant concurrent effect across all tracked parameters (p < 0.001). Integrating dhikr with deep breathing exercise effectively minimises psychological distress in individuals with chronic kidney disease, providing a viable non-pharmacological complementary modality.

References

Amir, F., Mastutik, G., Hasinuddin, M., & Putra, S. T. (2018). Dhikr (Recitation) and Relaxation Improve Stress Perception and Reduce Blood Cortisol Level in Type 2 Diabetes Mellitus Patients with OAD. Folia Medica Indonesiana, 54(4), 249. https://doi.org/10.20473/fmi.v54i4.10707

Angesti, V. Y., & Purwanti, O. S. (2025). Relationship Between Hemodialysis Length , Frequency , and Anxiety in Chronic Kidney Disease Patients. 95–107. https://doi.org/10.33221/jiiki.v15i02.4006

Anggun, M., Kusumawinakhyu, T., Wiharto, & Mustikawati, I. (2021). The Effect Of Dhikr On Anxiety And Deppresion Level In Hemodialysis Patients At Purwokerto Islamic Hospital. International Journal of Islamic and Complementary Medicine, 2, 15–25. https://doi.org/10.55116/IJIM.V1I1.15

Ayulia, V., & Hidayat, R. (2024). Effect of Dhikr Therapy on Quality of Life in Hemodialysis Patients with Chronic Kidney Disease. Omni Nursing Journal, 1(4), 129–135. https://doi.org/10.65277/onj.v1i4.139

Bakker, W. M., Theunissen, M., Öztürk, E., Litjens, E., Courtens, A., van den Beuken- van Everdingen, M. H. J., & Hemmelder, M. H. (2024). Educational level and gender are associated with emotional well-being in a cohort of Dutch dialysis patients. BMC Nephrology, 25(1), 179. https://doi.org/10.1186/s12882-024-03617-8

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. International Urology and Nephrology, 55(4), 897–912. https://doi.org/10.1007/s11255-022-03374-3

Billany, R. E., Thopte, A., Adenwalla, S. F., March, D. S., Burton, J. O., & Graham-Brown, M. P. M. (2023). Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: a systematic review. Journal of Nephrology, 36(5), 1267–1281. https://doi.org/10.1007/s40620-022-01537-0

Boima, V., Agyekum, A. B., Ganatra, K., Agyekum, F., Kwakyi, E., Inusah, J., Ametefe, E. N., & Adu, D. (2025). Advances in kidney disease: pathogenesis and therapeutic targets. Frontiers in Medicine, Volume 12. https://doi.org/10.3389/fmed.2025.1526090

Boswell, L., Vega-Beyhart, A., Blasco, M., Quintana, L. F., Rodríguez, G., Díaz-Catalán, D., Vilardell, C., Claro, M., Mora, M., Amor, A. J., Casals, G., & Hanzu, F. A. (2024). Hair cortisol and changes in cortisol dynamics in chronic kidney disease. Frontiers in Endocrinology, 15, 1282564. https://doi.org/10.3389/fendo.2024.1282564

Brennan, E., Kantharidis, P., Cooper, M. E., & Godson, C. (2021). Pro-resolving lipid mediators: regulators of inflammation, metabolism and kidney function. Nature Reviews Nephrology, 17(11), 725–739. https://doi.org/10.1038/s41581-021-00454-y

Brown, E. A., Zhao, J., McCullough, K., Fuller, D. S., Figueiredo, A. E., Bieber, B., Finkelstein, F. O., Shen, J., Kanjanabuch, T., Kawanishi, H., Pisoni, R. L., & Perl, J. (2021). Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 78(4), 489-500.e1. https://doi.org/10.1053/j.ajkd.2021.02.327

Bruce, M. A., Griffith, D. M., & Thorpe, R. J. J. (2015). Stress and the kidney. Advances in Chronic Kidney Disease, 22(1), 46–53. https://doi.org/10.1053/j.ackd.2014.06.008

Calisanie, N. N. P., & Ira Santika. (2022). The Effectiveness of the Combination of Spiritual Emotional Freedom Technique and Slow Deep Breathing in Lowering Blood Pressure Reduction in Hypertensive Patients at UPT Puskesmas Pasundan, Bandung City . Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 8(Special Edition SE-Articles).

Cheng, L., Liu, Y., Chen, Q., & Zhang, F. (2025). Exploring the spiritual experiences of older adults with chronic diseases: a qualitative study in a multicultural context. BMC Psychology, 13(1), 632. https://doi.org/10.1186/s40359-025-02710-3

Chiou, C.-P., Bai, Y.-L., Lai, L.-Y., Hsieh, H.-C., & Chang, S.-T. (2023). Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis. BMC Public Health, 23(1), 237. https://doi.org/10.1186/s12889-023-15140-w

Choudhary, S. K., & Zagade, T. B. (2025). Efficacy of Deep Breathing Exercise and Range of Motion Exercise on Depression, Anxiety, and Stress in Patients with Chronic Kidney Disease Undergoing Hemodialysis. Journal of Pharmacy & Bioallied Sciences, 17(Suppl 3), S2566–S2568. https://doi.org/10.4103/jpbs.jpbs_916_25

Dalal, K., Sankhe, A., & Zope, J. (2021). A Prospective, Controlled Study to Assess Effect of Spiritual Therapy in Patient Undergoing Hemodialysis at Bhaktivedanta Hospital. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 32(6), 1570–1576. https://doi.org/10.4103/1319-2442.352417

Deng, L., Guo, S., Liu, Y., Zhou, Y., Liu, Y., Zheng, X., Yu, X., & Shuai, P. (2025). Global, regional, and national burden of chronic kidney disease and its underlying etiologies from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. BMC Public Health, 25(1), 636. https://doi.org/10.1186/s12889-025-21851-z

Dobrakowski, P., Blaszkiewicz, M., & Skalski, S. (2020). Changes in the Electrical Activity of the Brain in the Alpha and Theta Bands during Prayer and Meditation. In International Journal of Environmental Research and Public Health (Vol. 17, Issue 24, p. 9567). https://doi.org/10.3390/ijerph17249567

Dr.Arul Valan, Mr.Gopinath, & Ms.Manjusha. (2024). Reducing Anxiety in Patients Undergoing Hemodialysis with Spiritual Mindfulness Based on Breathing Exercise. The Bioscan, 19(Supplement 1 SE-Articles), 54–56. https://doi.org/10.63001/tbs.2024.v19.i02.S1.pp54-56

Elezi, B., Abazaj, E., Zappacosta, B., & Hoxha, M. (2023). Anxiety and depression in geriatric hemodialysis patients: factors that influence the border of diseases. Frontiers in Psychology, Volume 14-2023. https://doi.org/10.3389/fpsyg.2023.1281878

Farhani, S. N., & Qudsyi, H. (2024). Terapi dzikir untuk menurunkan tingkat kecemasan pada pasien hemodialisa. Procedia : Studi Kasus Dan Intervensi Psikologi, 12(3 SE-Journal), 105–110. https://doi.org/10.22219/procedia.v12i3.32599

Farooq, N. (2024). The Impact of Salah (Prayer) and Dhikr on Stress Reduction and Emotional Regulation. International Journal Of Islamic Psychology, 1(2 SE-Articles), 34–44.

Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1), 432. https://doi.org/10.1038/s41598-022-27247-y

Firmanda, G., & Wahyuningsih, A. (2025). The Audiovisual-Based Health Education as a Therapeutic Modality for Managing Anxiety in CKD Patients Facing Fluid Intake Limitations. Adi Husada Nursing Journal, 11, 10. https://doi.org/10.37036/ahnj.v11i1.619

Fradelos, E. C. (2021). Spiritual Well-Being and Associated Factors in End-Stage Renal Disease. TheScientificWorldJournal, 2021, 6636854. https://doi.org/10.1155/2021/6636854

Garg, R., Memon, S. S., Lila, A., Sarathi, V., Patil, P., Jamale, T., Bose, S., Karlekar, M., Patil, V., Shah, N., & Bandgar, T. (2024). Overnight 1-mg DST Serum Cortisol in Various Stages of Chronic Kidney Disease-Normative Data and Underlying Mechanisms. Journal of the Endocrine Society, 8(3), bvae002. https://doi.org/10.1210/jendso/bvae002

Gerritsen, R. J. S., & Band, G. P. H. (2018). Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Frontiers in Human Neuroscience, 12, 397. https://doi.org/10.3389/fnhum.2018.00397

Ghasemi Bahraseman, Z., Mangolian Shahrbabaki, P., & Nouhi, E. (2021). The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial. BMC Psychology, 9(1), 177. https://doi.org/10.1186/s40359-021-00678-4

Guo, J., Jiao, W., Xia, S., Xiang, X., Zhang, Y., Ge, X., & Sun, Q. (2025). The global, regional, and national patterns of change in the burden of chronic kidney disease from 1990 to 2021. BMC Nephrology, 26(1), 136. https://doi.org/10.1186/s12882-025-04028-z

Guyton, A. C., & Hall, J. E. (2021). Guyton and Hall Textbook of Medical Physiology (14th ed.). Philadelphia, PA : Elsevier.

Hall, R. K., Kazancıoğlu, R., Thanachayanont, T., Wong, G., Sabanayagam, D., Battistella, M., Ahmed, S. B., Inker, L. A., Barreto, E. F., Fu, E. L., Clase, C. M., & Carrero, J. J. (2024). Drug stewardship in chronic kidney disease to achieve effective and safe medication use. Nature Reviews. Nephrology, 20(6), 386–401. https://doi.org/10.1038/s41581-024-00823-3

Hidayangsih, P. S., Tjandrarini, D. H., Widya Sukoco, N. E., Sitorus, N., Dharmayanti, I., & Ahmadi, F. (2023). Chronic kidney disease in Indonesia: evidence from a national health survey. Osong Public Health and Research Perspectives, 14(1), 23–30. https://doi.org/10.24171/j.phrp.2022.0290

Ho, R. T. H., Lo, H. H. M., Fong, T. C. T., & Choi, C. W. (2020). Effects of a Mindfulness-based Intervention on diurnal cortisol pattern in disadvantaged families: A randomized controlled trial. Psychoneuroendocrinology, 117, 104696. https://doi.org/10.1016/j.psyneuen.2020.104696

Huang, C. W., Wee, P. H., Low, L. L., Koong, Y. L. A., Htay, H., Fan, Q., Foo, W. Y. M., & Seng, J. J. B. (2021). Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: A systematic review and meta-analysis. General Hospital Psychiatry, 69, 27–40. https://doi.org/10.1016/j.genhosppsych.2020.12.003

Huang, J., Mao, Y., Zhao, X., Liu, Q., & Zheng, T. (2023). Association of anxiety, depression symptoms and sleep quality with chronic kidney disease among older Chinese. Medicine, 102(43), e35812. https://doi.org/10.1097/MD.0000000000035812

Hustrini, N. M., Susalit, E., Widjaja, F. F., Khumaedi, A. I., Dekkers, O. M., van Diepen, M., & Rotmans, J. I. (2024). The Etiology of Advanced Chronic Kidney Disease in Southeast Asia: A Meta-analysis. Journal of Epidemiology and Global Health, 14(3), 740–764. https://doi.org/10.1007/s44197-024-00209-5

Hutagaol, A. Y., Magda Siringo-ringo, & Nagoklan Simbolon. (2022). Description of the Anxiety Level of Chronic Kidney Failure Patients Undergoing Hemodialysis at the Haji Adam Malik General Hospital Medan In 2021. Science Midwifery, 10(3 SE-Articles), 2296–2302. https://doi.org/10.35335/midwifery.v10i3.300

Huwaidah, I. R., & Sumarti, H. (2024). Alpha Wave Activity on Think Hard and Dhikr Condition Using Electroencephalographic ( EEG ). Physic Education Research Journal, 6(1), 53–58. https://doi.org/10.21580/perj.2024.6.1.15200

Insyra, A. R., Alfarizi, A. F., & Zakiyyah, N. A. (2023). The Effect of Dhikr Therapy on Stress Reduction: Literature Review. Proceeding Conference on Da’wah and Communication Studies, 2(1 SE-Articles), 5–16. https://doi.org/10.61994/cdcs.v2i1.88

Isehunwa, O. O., Warner, E. T., Spiegelman, D., Huang, T., Tworoger, S. S., Kent, B. V., & Shields, A. E. (2021). Religion, spirituality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women. Comprehensive Psychoneuroendocrinology, June, 100064. https://doi.org/10.1016/j.cpnec.2021.100064

Kalyani, M., Kumar, J. A., & Panuganti, P. K. (2025). Immediate Effects Of Structured Deep Breathing On Cardiovascular Function, Autonomic Regulation, And Perceived Stress In Healthy Adults. Journal of Population Therapeutics & Clinical Pharmacology, 32(09), 950–958. https://doi.org/10.53555/jzyqep12

Katyal, S., & Goldin, P. (2021). Alpha and theta oscillations are inversely related to progressive levels of meditation depth. Neuroscience of Consciousness, 2021(1), niab042. https://doi.org/10.1093/nc/niab042

Kavitha, N., Pal, P., Pal, G. K., Bharadwaj, B., & Nanda, N. (2024). Effects of Slow Breathing Exercises on Cardiac Autonomic Functions in Anxiety Disorder — A Randomised Control Trial. Annals of Neurosciences. https://doi.org/10.1177/09727531241266094

KDIGO. (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International, 105(4S), S117–S314. https://doi.org/10.1016/j.kint.2023.10.018

Khotimah, R., & Nurjannah, N. (2024). Implementasi Zikir Sebagai Upaya Mereduksi Cemas Melalui Pendekatan Cognitive Behavioral Therapy (CBT). At-Taujih : Bimbingan Dan Konseling Islam, 7(1 SE-Articel), 57–67. https://doi.org/10.22373/taujih.v7i1.18757

Kirkeskov, L., Carlsen, R. K., Lund, T., & Buus, N. H. (2021). Employment of patients with kidney failure treated with dialysis or kidney transplantation—a systematic review and meta-analysis. BMC Nephrology, 22(1), 348. https://doi.org/10.1186/s12882-021-02552-2

Kurdziel, L. B. F., McDevitt, L., & Hardway, C. (2025). Acute Effects of Slow-Paced Breathing on Emotion Regulation: A Pilot Study. Sage Journal, 10(12), 732–742. https://doi.org/https://doi.org/10.1177/00332941251329856

Kusmiran, E., Tentry Fuji Purwanti, & Hani Hanafiah. (2026). Analysis of Hemodialysis Duration as a Determining Factor of Quality of Life in Patients with Chronic Kidney Disease : A Cross-Sectional Study at Regional General Hospital, Bandung Regency, 2024. Journal Of Nursing Practice, 9(2 SE-Articles), 289–297. https://doi.org/10.30994/jnp.v9i2.953

LeBouef, T., Yaker, Z., & Whited, L. (2023). Physiology, Autonomic Nervous System.

Levin, A., Ahmed, S. B., Carrero, J. J., Foster, B., Francis, A., Hall, R. K., Herrington, W. G., Hill, G., Inker, L. A., Kazancıoğlu, R., Lamb, E., Lin, P., Madero, M., McIntyre, N., Morrow, K., Roberts, G., Sabanayagam, D., Schaeffner, E., Shlipak, M., … Stevens, P. E. (2024). Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney International, 105(4), 684–701. https://doi.org/10.1016/j.kint.2023.10.016

Luca, A.-L., Militaru, F., Mușat, M. I., Udriștoiu, I., & Moța, E. (2026). Longitudinal Changes in Depression, Anxiety and Stress Symptoms Among Hemodialysis Patients. In Clinics and Practice (Vol. 16, Issue 2, p. 37). https://doi.org/10.3390/clinpract16020037

Ma’rufah, Q. A., & Ridho, M. T. (2026). The Integration of Dhikr and Reflection as a Coping Strategy for Managing Anxiety Symptoms. In West Science Islamic Studies (Vol. 4, Issues 02 SE-Articles, pp. 117–124). https://doi.org/10.58812/wsiss.v4i02.2804

Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Scientific Reports, 11(1), 19267. https://doi.org/10.1038/s41598-021-98736-9

Mahyuvi, T., & Sari, N. (2023). Overcoming Anxiety Chronic Kidney Failure Patients with Spiritual Mindfulness Intervention: A Case study. Nursing Science Journal (NSJ), 7(2), 63–74.

Manalu, L., Latifah, N., & Arifin, A. (2021). Efektivitas Pemberian Edukasi Kesehatan Terhadap Tingkat Kecemasan Pasien Gagal Ginjal Kronis yang dihemodialisa di RSKG Ny. Ra Habibie Bandung. Risenologi, 6, 70–75. https://doi.org/10.47028/j.risenologi.2021.61a.215

Manisha, M., Tukimin Bin Sansuwito, & Idris Adewale Ahmed. (2025). Effectiveness of the Islamic Spiritual Care to Control Stress and Improve Spiritual Life Among Patients with Chronic Diseases: A Systematic Literature Review. International Journal of Biotechnology and Biomedicine (IJBB), 2(2 SE-), 25–38. https://doi.org/10.31674/ijbb.2025.v02i02.003

Masita, N. A., & Cholil. (2025). Dhikr as an Adaptive Spiritual Strategy: Exploring the Healing Mechanism for Anxiety from The Islamic Perspective. Istisyarah: Jurnal Bimbingan Konseling Islam, 1(1), 38–44. https://doi.org/10.23971/IJBKI.pytyf711

Motrenikova, M., Boyanov, K., Bojinova, N., & Bivolarska, A. (2025). Stress Pathways in Chronic Kidney Disease: Linking Cortisol, Oxidative Stress, and Inflammation. Antioxidants, 14(10). https://doi.org/10.3390/antiox14101259

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

Ningrum, R. Y. S., Astuti, D., & Puspasari, F. D. (2023). Literature Review Pengaruh Relaksasi Dzikir Terhadap Stres Pada Pasien Chronic Kidney Disease. Journal Of Nursing & Health, 169–175.

Noushad, S., Ahmed, S., Ansari, B., Mustafa, U.-H., Saleem, Y., & Hazrat, H. (2021). Physiological biomarkers of chronic stress: A systematic review. International Journal of Health Sciences, 15(5), 46–59.

Nugraha Kusuma, A., Rahmawati, D., Lusiani, M., & Dede, R. (2020). The effect of Dhikr therapy on anxiety levels in chronic kidney failure patients that have done hemodialysis therapy in Indonesia. Enfermería Clínica, 30, 175–178. https://doi.org/https://doi.org/10.1016/j.enfcli.2019.11.048

Nurbadriyah, W. D., & Widyawati, I. Y. (2023). Do spiritual religious coping strategies affect quality of life in patients with chronic kidney disease? A systematic review. In JPMA. The Journal of the Pakistan Medical Association: Vol. 73(Suppl 2 (Issue 2, pp. S148–S152). https://doi.org/10.47391/JPMA.Ind-S2-34

Okviasanti, F., Putra, S. T., Bakar, A., & Yusuf, A. (2023). Effects of Dhikr on Spirituality and Cortisol Levels Among Patients With Heart Failure: a Pilot Study. Journal of Vocational Nursing, 4(1), 82–86. https://doi.org/10.20473/jovin.v4i1.45327

Panma, Y. (2025). Factors Associated with Spirituality in Patient Undergoing Hemodialysis . Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 11(1 SE-Articles), 30–38. https://doi.org/10.33755/jkk.v11i1.793

Pretscher, A., Kauzner, S., Rohleder, N., & Becker, L. (2021). Associations between social burden, perceived stress, and diurnal cortisol profiles in older adults: implications for cognitive aging. European Journal of Ageing, 18(4), 575–590. https://doi.org/10.1007/s10433-021-00616-8

Rajiah, P. S., Suman, G., Vijay, K., Venugopal, N., Chalian, M., & Agarwal, A. K. (2024). Multisystem Imaging Manifestations of Kidney Failure. RadioGraphics, 44(8). https://doi.org/https://doi.org/10.1148/rg.230124

Rauzah, M., Husna, C., & Syarif, H. (2025). The effectiveness of spiritual education on the uncertainty of illness in hemodialysis patients. Nursing and Health Sciences Journal (NHSJ), 05(03), 322–331.

Riskesdas Jatim. (2021). Profil Kesehatan Dinas Kesehatan Provinsi Jawa Timur 2021. Dinas Kesehatan Provinsi Jawa Timur, tabel 53.

Sagmeister, M. S., Harper, L., & Hardy, R. S. (2022). Cortisol excess in chronic kidney disease - A review of changes and impact on mortality. Frontiers in Endocrinology, 13, 1075809. https://doi.org/10.3389/fendo.2022.1075809

Sawiji, S., Said, F. M., Aljaberi, M. A., & Huda, A. (2024). Therapeutic Spiritual-Community Model (TSCM) for Anxiety Reduction in Haemodialysis Patients: A Controlled Pilot Study. Journal of Angiotherapy, 8(8). https://doi.org/10.25163/angiotherapy.889840

Senmar, M., Razaghpoor, A., Mousavi, A. S., Zarrinkolah, F., Esmaeili, F., & Rafiei, H. (2020). Psychological Symptoms in Patients on Dialysis and Their Relationship with Spiritual Well-Being. Florence Nightingale Journal of Nursing, 28(3), 243–249. https://doi.org/10.5152/FNJN.2020.19061

Sobhani, V., Manshadi Mokari, E., Aghajani, J., & Hatef, B. (2022). Islamic praying changes stress-related hormones and genes. Journal of Medicine and Life, 15(4), 483–488. https://doi.org/10.25122/jml-2021-0167

Sopiah, P., Nuryani, R., Sukaesih, N. S., Lindasari, S. W., & Assyfa, N. (2024). The Dhikir and Prayer Therapy on Reducing Blood Pressure in Hypertension Patients: Systematic Literature Review. Care : Jurnal Ilmiah Ilmu Kesehatan, 12(2), 238–252. https://doi.org/10.33366/jc.v12i2.5234

Su, G., Song, H., Lanka, V., Liu, X., Fang, F., Valdimarsdóttir, U. A., & Carrero, J. J. (2021). Stress Related Disorders and the Risk of Kidney Disease. Kidney International Reports, 6(3), 706–715. https://doi.org/10.1016/j.ekir.2020.12.032

Sudrajat, M. F. F., Djuria, S. A., & Sudrajat, A. (2025). Hubungan Kesejahteraan Spiritual Terhadap Kecemasan Pada Pasien Chronic Kidney Disease (CKD) Yang Menjalani Hemodialisa DI RSUD dr Adjidarmo Rangkasbitung. Jurnal Ilmiah Keperawatan, 6(1), 95–106.

Supriyono, S., Kusnanto, K., & Abidin, Z. (2020). Strategi Koping Dengan Pendekatan Spiritual Pada Pasien Chronic Kidney Disease (CKD) Yang Menjalani Hemodialis: Studi Fenomenologi: Coping Strategies with Spiritual Approaches in Chronic Kidney Disease (CKD) Patients Undergoing Hemodialysis: Phenomenology. Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing), 6(1 SE-), 87–92. https://doi.org/10.33023/jikep.v6i1.446

Tata Mahyuvi, & Novita Sari. (2024). Reducing Anxiety in Patients Undergoing Hemodialysis with Spiritual Mindfulness Based On Breathing Exercise. Journal Of Nursing Practice, 7(2 SE-Articles), 252–261. https://doi.org/10.30994/jnp.v7i2.385

Torres, V. E., Ahn, C., Barten, T. R. M., Brosnahan, G., Cadnapaphornchai, M. A., Chapman, A. B., Cornec-Le Gall, E., Drenth, J. P. H., Gansevoort, R. T., Harris, P. C., Harris, T., Horie, S., Liebau, M. C., Liew, M., Mallett, A. J., Mei, C., Mekahli, D., Odland, D., Ong, A. C. M., … Devuyst, O. (2025). KDIGO 2025 clinical practice guideline for the evaluation, management, and treatment of autosomal dominant polycystic kidney disease (ADPKD): executive summary. Kidney International, 107(2), 234–254. https://doi.org/10.1016/j.kint.2024.07.010

van der Velpen, I. F., de Feijter, M., Raina, R., Özel, F., Perry, M., Ikram, M. A., Vernooij, M. W., & Luik, A. I. (2023). Psychosocial health modifies associations between HPA-axis function and brain structure in older age. Psychoneuroendocrinology, 153, 106106. https://doi.org/10.1016/j.psyneuen.2023.106106

Vargas-Uricoechea, H., Castellanos-Pinedo, A., Urrego-Noguera, K., Vargas-Sierra, H. D., Pinzón-Fernández, M. V, Barceló-Martínez, E., & Ramírez-Giraldo, A. F. (2024). Mindfulness-Based Interventions and the Hypothalamic–Pituitary–Adrenal Axis: A Systematic Review. Neurology International, 16(6), 1552–1584. https://doi.org/10.3390/neurolint16060115

Vondracek, S. F., Teitelbaum, I., & Kiser, T. H. (2021). Principles of Kidney Pharmacotherapy for the Nephrologist: Core Curriculum 2021. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 78(3), 442–458. https://doi.org/10.1053/j.ajkd.2021.02.342

Wang, X. H., Mitch, W. E., & Price, S. R. (2022). Pathophysiological mechanisms leading to muscle loss in chronic kidney disease. Nature Reviews Nephrology, 18(3), 138–152. https://doi.org/10.1038/s41581-021-00498-0

Wei, C.-J., Shih, C.-L., Hsu, Y.-J., Chen, Y.-C., Yeh, J.-Z., Shih, J.-H., & Chiu, C.-H. (2021). Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan. BMJ Open, 11, e052597. https://doi.org/10.1136/bmjopen-2021-052597

Wijayanti, L., Septianingrum, Y., Sultoni, A., Fitriasari, A., Wardani, E., & Ramadhani, L. (2025). Effectiveness of Combination Dhikr and Salawat on Anxiety and Sleep Quality in Hemodialysis Patients in Indonesia: A Randomized Controlled Trial. Journal of Religion and Health, 64, 2542–2557. https://doi.org/10.1007/s10943-025-02342-2

Xie, K., Cao, H., Ling, S., Zhong, J., Chen, H., Chen, P., & Huang, R. (2025). Global, regional, and national burden of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021. Frontiers in Endocrinology, 16, 1526482. https://doi.org/10.3389/fendo.2025.1526482

Yuniartika, W., Sudaryanto, A., & Kumalasari, A. Z. (2021). Reducing anxiety level by using progressive relaxation among the elderly people in the nursing home. Enfermería Clínica, 31, S381–S385. https://doi.org/https://doi.org/10.1016/j.enfcli.2020.09.030

Yusuf, A., Iswari, M. F., Sriyono, S., & Yunitasari, E. (2020). The effect of combination of spiritual deep breathing exercise therapy on pain and anxiety in postoperative nonpatological orthopedic fracture patients. EurAsian Journal of BioSciences, 14(1), 1625–1631.

Zaragoza Fernández, G. M., Jiménez Mayor, E., Chandu Nanwani, A., Rodríguez Tudero, C., De La Flor, J. C., & Fernández Castillo, R. (2025). Biochemical Associations with Depression, Anxiety, and Stress in Hemodialysis: The Role of Albumin, Calcium, and β2-Microglobulin According to Gender. In Biomedicines (Vol. 13, Issue 12, p. 3092). https://doi.org/10.3390/biomedicines13123092

Zhang, J., Xu, F., Zhuang, P., Xu, X., Zou, Z., & Qing, W. (2025). Effects of health education based on self-determination theory on hemodialysis knowledge and self-management in maintenance hemodialysis patients. Scientific Reports, 15(1), 15982. https://doi.org/10.1038/s41598-025-01152-6

Zhu, Y., Jha, S. C., Shutta, K. H., Huang, T., Balasubramanian, R., Clish, C. B., Hankinson, S. E., & Kubzansky, L. D. (2022). Psychological Distress and Metabolomic Markers: A Systematic Review. MedRxiv, 2022.02.24.22271464.

Zuo, Y., Zha, D., Zhang, Y., Yang, W., Jiang, J., Wang, K., Zhang, R., Chen, Z., & He, Q. (2024). Dysregulation of the 3β-hydroxysteroid dehydrogenase type 2 enzyme and steroid hormone biosynthesis in chronic kidney disease. Frontiers in Endocrinology, Volume 15-2024. https://doi.org/10.3389/fendo.2024.1358124

Downloads

Published

2026-09-25

How to Cite

Wulandari, M., Krisnawati, D. I., & Zahroh, C. (2026). The Effects of Dhikr Combined with Deep Breathing Exercises on Stress, Anxiety, and Cortisol Levels among Chronic Kidney Disease (CKD) Patients. Indonesian Journal of Global Health Research, 8(5), 687–710. https://doi.org/10.37287/ijghr.v8i5.2328

Similar Articles

<< < 9 10 11 12 13 14 15 16 > >> 

You may also start an advanced similarity search for this article.