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Yiting Wang,1,2 Xinyue Zhang,1,2 Lei Lan,1,2 Yuzhu Qu,1– 3 Yuting Wang,1,2 Jie Chen,4 Li-Wei Chou,5– 7,* Fang Zeng1,2,* 1Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People’s Republic of China; 2Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu, Sichuan, 611137, People’s Republic of China; 3Post-Doctoral Scientific Research Workstation of Affiliated Sport Hospital, Chengdu Sport University, Chengdu, Sichuan, 610041, People’s Republic of China; 4Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, 611730, People’s Republic of China; 5Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 6Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan; 7Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Fang Zeng, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan, 611137, People’s Republic of China, Email zengfang@cdutcm.edu.cn Li-Wei Chou, Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, 404332, Taiwan, Email chouliwe@gmail.comIntroduction: Patients undergoing hemodialysis (HD) frequently experience sleep disturbances and mental health disorders. Given the adverse effects of relevant pharmacological treatments, acupressure has been explored as a potential alternative. This study aimed to evaluate the efficacy and safety of acupressure in improving sleep quality, mental health, and related outcomes in patients undergoing HD.Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across seven databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, and VIP) from inception to March 2025. We included trials comparing acupressure (including auricular acupressure) with medication or waiting-list controls in patients with HD.Results: Twenty-seven studies involving 2037 participants were included in the statistical analysis. Compared to waiting-list, moderate certainty evidence suggests that acupressure probably improves sleep quality (weighted mean difference (WMD) -3.51 points on the 21-point Pittsburgh Sleep Quality Index (PSQI) scale, 95% confidence interval (CI) − 4.14 to − 2.89) and quality of life (WMD 9.66 points on the 100-point SF-36 scale, 95% CI 6.65 to 12.66); low certainty evidence suggests that acupressure may have little impact on sleep duration, mental health, and social functioning. Compared to medication treatment, low to very low certainty evidence suggests that acupressure may have little impact on sleep quality, social functioning, and sleep duration. Based on very limited evidence from only one study, there may be little to no difference in adverse effects between acupressure and medication groups (risk ratios (RR) 0.21, 95% CI 0.01 to 4.27).Conclusion: Compared to the waiting-list, acupressure likely improves sleep quality and quality of life, while having a minimal impact on mental health, sleep duration, and social functioning in HD patients. However, its benefits over those of other medications remain unclear.Systematic Review Registration: www.crd.york.ac.uk/PROSPERO/, ID: CRD420251010657.Keywords: acupressure, hemodialysis, sleep quality, mental health, meta-analysis