Dear editor 
Patients undergoing Maintenance Hemodialysis (MHD) face a variety of physical and psychological challenges. The routine nature of hemodialysis sessions, along with dietary and fluid restrictions, often leaves patients feeling weak, tired, and physically vulnerable. These feelings are compounded by the emotional and psychological challenges associated with chronic illness and ongoing treatment. This treatment can lead to complications such as fluid and electrolyte imbalances, muscle cramps, vascular issues, and extreme fatigue, all of which significantly impact their quality of life (1). A study has shown that patients undergoing MHD generally experience a low quality of life, as indicated by the overall quality of life score obtained from the standard SF-36 questionnaire. Women, the elderly, married patients, and those with three or more comorbidities scored the lowest, with these groups having the worst quality of life among hemodialysis patients. This research highlights the burden that both the disease and the treatment process place on patients, and suggests that improving the determinants of quality of life should be a priority when addressing the challenges(2).
The time-consuming nature of hemodialysis treatments contributes to high levels of anxiety, depression, and social isolation. The physical exhaustion associated with frequent sessions also limits patients’ ability to engage in social, professional, and recreational activities, leading to withdrawal and disconnection from everyday life. This combination of physical and psychological challenges significantly reduces patients’ overall quality of life, emphasizing the urgent need for effective interventions that address both the physical and psychological aspects of their well-being (3).
Given the diverse challenges faced by patients undergoing MHD, there is a growing need for non-invasive, cost-effective interventions that can improve their quality of life. While traditional treatments, such as medications for pain and anxiety, may provide symptom relief, they often come with side effects and may not fully address the psychological burdens associated with chronic illness. Consequently, there is increasing interest in mind-body therapies, such as guided imagery, which offer an accessible and effective alternative (4).
This approach is a therapeutic technique that involves using mental visualization to induce relaxation, reduce stress, and enhance emotional well-being. By guiding individuals through visualizations of calming environments like beaches, forests, or serene landscapes, the approach activates the parasympathetic nervous system, which counteracts the body’s stress response. This activation results in a lower heart rate, reduced blood pressure, and an overall sense of relaxation. By stimulating the parasympathetic nervous system, it helps create a physiological environment that supports stress reduction and emotional recovery (5).
In another study, it was found that guided meditation had a significant effect on the quality of life of patients with End-Stage Renal Disease (ESRD) undergoing MHD. Following the intervention, guided meditation resulted in statistically significant improvements in happiness, enthusiasm, activity, inspiration, alertness, stability, awareness, self-confidence, clarity of thought, anger control, and self-reflection in the intervention group. It also reduced perceived stress. In terms of qualitative well-being, participants reported feeling calm and inspired to manage their disease or continue regular activities, increased clarity of thought, improved concentration, happiness, reduced laziness, reduced anger, better sleep patterns, and other psychological benefits from using this approach (6).
For patients undergoing hemodialysis, the physiological benefits of guided imagery stem from its ability to moderate the response to stress, providing a more balanced emotional and physical state for patients managing long-term health conditions. It helps alleviate discomfort, anxiety, and social isolation, which are commonly associated with treatment. By fostering relaxation and reducing stress, it can make sessions more comfortable. It helps alleviate physical symptoms such as muscle cramps, fatigue, and discomfort, and enables patients to better cope with the psychological challenges by fostering emotional stability and resilience. This, in turn, allows patients to improve their overall quality of life (7). 

Conclusion
The quality of life for patients undergoing MHD is significantly impacted by the physical and psychological burdens associated with chronic kidney disease. Given the complexity of these challenges, it is essential to explore innovative, non-invasive, and cost-effective interventions that address both physical and psychological health. Guided imagery offers a promising approach to improving the well-being of patients by inducing relaxation, reducing stress, and enhancing emotional recovery. By alleviating physical discomfort and supporting mental health, guided imagery has the potential to manage the complex burdens of chronic illness. Future research could involve conducting interventional studies with a longer duration, larger sample size, and long-term follow-up, as well as external validation of the instrument designed by the researcher. Additionally, studying the effects of guided meditation on physiological and biochemical parameters could further enhance scientific follow-up.

Conflict of Interest
There was no conflict of interest in this manuscript.