Dear Editor 
Patients undergoing hemodialysis face a variety of challenges that impact their physical, emotional, and psychological well-being, ultimately reducing their quality of life. Despite these burdens, the spiritual needs of these patients are often neglected in clinical settings. While medical care usually focuses on physical symptoms, growing evidence highlights the significance of spirituality in promoting overall health. Spirituality, defined as a connection to something greater than oneself, can provide comfort and resilience, particularly for those living with chronic illnesses. For these patients, the physical and emotional strains of treatment increase the need for spiritual support, which can enhance quality of life, alleviate emotional distress, and restore a sense of purpose (Gebrie et al., 2023; Aghakhani et al., 2011).
The frequent hospital visits and extended treatment sessions required for hemodialysis can shift the focus of healthcare providers primarily toward physical concerns, like fluid balance and treatment effectiveness. Consequently, patients’ emotional and spiritual needs are often overlooked. Additionally, many healthcare providers feel ill-equipped to handle spiritual matters, which delays the inclusion of spiritual care in regular treatment. A major obstacle is the belief that spirituality has no effect on clinical outcomes or that it should be kept separate from medical practice (Fradelos et al., 2022).
Spiritual well-being is crucial for the mental health and physical recovery of patients undergoing hemodialysis, leading to improved clinical outcomes. Many individuals on hemodialysis feel isolated and hopeless, which can worsen anxiety and depression if not addressed. Practices such as prayer, meditation, and spiritual counseling have been shown to reduce emotional strain, enhance patient satisfaction, and foster resilience. Despite these documented benefits, spiritual care is often underutilized in hemodialysis treatment due to misconceptions about its importance in medical care (Fradelos, 2021).
Integrating spiritual care into the routine management of hemodialysis is crucial for enhancing patient recovery. An interdisciplinary approach, involving nephrologists, nurses, psychologists, and social workers, ensures that the full spectrum of a patient’s needs is addressed. Regular spiritual assessments enable healthcare providers to offer tailored support that respects and responds to patients’ emotional and spiritual concerns. This comprehensive approach not only strengthens coping mechanisms and alleviates depression but also creates a more supportive environment where both emotional and spiritual needs are prioritized alongside physical care. Ultimately, the inclusion of spiritual care in hemodialysis treatment leads to improved clinical outcomes and enhances overall patient well-being (Fradelos et al., 2017).

Conclusion
The integration of spiritual care into the treatment of hemodialysis patients is not just a complementary aspect of care, but a critical component of holistic healing. Addressing the emotional, psychological, and spiritual needs of these patients can significantly improve their overall well-being, reduce distress, and promote resilience in the face of chronic illness. Despite its proven benefits, spiritual care has remained underused due to misconceptions and the prioritization of physical health concerns. By adopting an interdisciplinary approach that incorporates regular spiritual assessments and a comprehensive focus on the full spectrum of patient needs, healthcare providers can improve both clinical outcomes and patient satisfaction. 

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research."

Conflict of interest
The authors declared no conflict of interest.

Funding 
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
All authors equally contributed to the design, implementation, and writing of all aspects of the manuscript. 

Acknowledgments
The authors want to thank the authors of the articles referenced in this letter.


References
Aghakhani, N., et al., 2011. Quality of life during hemodialysis and study dialysis treatment in patients referred to teaching hospitals in Urmia, Iran in 2007. Caspian Journal of Internal Medicine, 2(1), pp. 183-8. [PMID] 
Fradelos, E. C., et al, 2022. The effect of spirituality in quality of life of hemodialysis patients. Journal of Religion and Health, 61(3), pp. 2029-40.  [DOI:10.1007/s10943-020-01153-x] [PMID]
Fradelos, E. C., et al., 2017. Clinical, social and demographics factors associated with spiritual wellbeing in end stage renal disease. Advances in Experimental Medicine and Biology, 987, pp. 77-88.  [DOI:10.1007/978-3-319-57379-3_8] [PMID]
Fradelos, E. C., 2021. Spiritual well-being and associated factors in end-stage renal disease. TheScientificWorldJournal, 2021, pp. 6636854. [DOI:10.1155/2021/6636854] [PMID] 
Gebrie, M. H., et al., 2023. Patients' experience of undergoing maintenance hemodialysis. An interview study from Ethiopia. Plos One, 18(5), pp. e0284422. [DOI:10.1371/journal.pone.0284422] [PMID]