Chronic kidney disease (CKD) is a significant public health concern that negatively affects human health at national and global levels. By the year 2050, the number of patients with CKD will anticipatingly increase by about 30 %.1 End-stage renal failure (ESRF) refers to irreversible organ damage requiring renal replacement therapy. Dialysis and kidney transplantation are the two primary therapeutic options for the ESRF. There are also two options for dialysis: peritoneal dialysis and hemodialysis, whereas hemodialysis is the more widely used therapy option. Hemodialysis (HD) is a therapy form that extends the patient's life by removing toxic compounds (such as urea and creatinine) accumulated in the body through an artificial membrane.2 Almost 75 % of the patients with CKD, which translates to an average of 60,000 patients, receive HD therapy in Turkey.3 Dialysis patients are required to receive their therapy continuously throughout their lives unless they get kidney transplantation.4

Notwithstanding that hemodialysis is the most frequently preferred therapy form, it potentially leads to several physical (fatigue, sleep disorders, pruritus, sexual dysfunction, etc.) and psychological issues (depression, poor quality of life, anxiety, etc.).5,6 Among these, fatigue is one of the most typically observed complaints among 60–70 % of HD patients.7,8

The experience of fatigue is complex, multidimensional, and subjective and involves both physical and psychological symptoms. Patients frequently characterize fatigue as a persistent weakness, prostration, or lack of energy that can impair physical functions.9 While physical symptoms of fatigue manifest as muscle weakness or myasthenia, psychological symptoms lead to reduced cognitive endurance.10 As in other chronic illnesses, fatigue in CKD is multifactorial and may ensue in different ways among patients. HD patients may find it challenging to manage their fatigue since it is a stressful state. Fatigued patients must exert more effort to engage in physical and cognitive activities.11

There are pharmacological and non-pharmacological methods used in fatigue therapy in HD patients. The drugs used in the pharmacological treatment are mostly cause-specific, such as regulating or preventing anemia, supplying vitamin D support, and ensuring and sustaining calcium and phosphorus balance; however, they cannot control fatigue effectively and desirably.12, 13, 14, 15 Non-pharmacological treatments have gained more popularity in recent years, in addition to pharmaceutical treatments.16 Indeed, there are several non-pharmacological approaches, such as aromatherapy, laughter therapy, Pilates, massage, and acupressure, to relieve fatigue.17, 18, 19 As one of these non-pharmacological approaches, the acupressure application accelerates the metabolism and relaxes the muscles.20

Acupressure and acupuncture are traditional treatment methods with roots in ancient Chinese medicine, dating back thousands of years. While acupuncture is applied by inserting thin needles into specific points on the body, acupressure is performed by applying manual pressure to the same points. These methods were developed to balance the flow of ‘qi’ (life energy) and are based on the idea that diseases are caused by energy imbalances in Chinese medicine. Today, these applications are used as non-pharmacological treatments, especially in the management of chronic fatigue, pain, stress, sleep disorders and some psychological symptoms.21, 22, 23, 24

Some non-pharmacological treatments (such as biofeedback, hypnotherapy, transcutaneous electrical nerve stimulation) require special sessions and settings. Acupressure offers practical advantages over other non-pharmacological treatments due to its ease of application, low cost, non-invasiveness, and in some cases rapid effect. This side-effect-free application is a simple and effective intervention and can be easily applied by patients and healthcare personnel without posing any risk of physical harm.25, 26

The acupressure method promotes the release of neurotransmitters that transfer signals along neurons by applying pressure to the meridians, known as energy pathways in the body, and that regulates endocrine and internal organ functions.27 Accordingly, it alleviates the patient's symptoms and relieves bodily fatigue.28 The most typical acupressure points are LI4, SP6, ST36, K1, and GB13 for fatigue therapy.29, 30, 31

The number of clinical studies examining the effects of acupressure applications in the relief of fatigue symptoms experienced by patients suffering from HD is increasing on a daily basis. The objective of this study was to provide a more comprehensive overview by synthesising the most recently published randomised controlled trials (RCTs) investigating the effects of acupressure applications on fatigue in haemodialysis patients. Moreover, the present meta-analysis constitutes an investigation into the effects of acupressure applications in accordance with their conceptual basis, content, total duration and presentation format. This study can also contribute to the development of programs to reduce the fatigue level of hemodialysis patients by better understanding that acupressure application may have beneficial effects on patient outcomes.