**1. Introduction**

Over the past three decades, significant advancements in the knowledge of and understanding of the treatment of end-stage kidney disease (ESKD) have been made. According to the biopsychosocial model, which is linked to ESKD, dialysis has biological, psychological, and social consequences [1]. However, many studies focus on the biological effects of dialysis, and little attention has been given to psychosocial issues in hemodialysis. The psychosocial stressors that patients undergoing dialysis therapy face are numerous. Based on the psychosocial model, each person is unique, and his or her stressors interact with each other, which illustrates their complexity [1].

Several psychosocial stressors have an impact on patients with ESKD. The disease and its treatment modalities impose several lifestyle changes. These include the impact of disease and treatment, dietary and fluid restrictions, functional limitations and sexual dysfunction, and future uncertainty and fear of death. Furthermore, family and social issues such as changes in family roles and changes in duties and responsibilities may add to psychosocial stressors among people on dialysis. Some of these stressors among dialysis patients may cause changes in patients' marital and occupational status, which lead to isolation and decrease quality of life. Commonly associated psychosocial issues include depression, anxiety, delirium, and withdrawal from dialysis. These stressors may differ in their occurrence and manifestation according

to the time of the dialysis. Understanding these issues and their impact on patients undergoing dialysis therapy will have positive implications for clinical practice and patients' outcomes. Priority should be given to prevention and early identification of these issues throughout the trajectory of the dialysis treatment. This chapter will focus on the most common psychosocial issues among people on hemodialysis.
