Table 1.

Summary of key facilitators, barriers, and recommendations for NRRT implementation in Palestine

Category	Key themes	Description
Facilitators	MOH Strategic Policies	Robust government leadership, policy frameworks, and structured nephrology care integration.
Facilitators	Prevention-Driven Health System	Early detection, proactive health policies, and risk-based interventions to reduce AKI burden.
Facilitators	Multidisciplinary Collaboration & Nephrologist Early Engagement	Involvement of nephrologists,pharmacists, radiologist, nurses, and other specialists to ensure timely interventions.
Facilitators	Institutional Endorsement for Nephrology Care	Hospital-based monitoring systems, intake/output charting, and daily creatinine tracking for high-risk patients.
Facilitators	Advancing Technological Innovation	Implementation of AI-driven diagnostics, novel biomarkers (e.g., Cystatin C, NGAL), and electronic alert systems for early AKI detection.
Barriers	Systemic Governance and Policy Barriers	Lack of nephrology-specific policies, fragmented health governance, and insufficient regulatory frameworks.
Barriers	Financial and Operational Constraints	Limited funding, outdated dialysis machines, and poor infrastructure for nephrology services.
Barriers	Human Resource Insufficiency	Shortage of nephrologists, lack of residency programs, and migration of specialists due to low salaries.
Barriers	Prevention Strategies and Awareness Challenges	Poor health literacy, delayed nephrology consultations, and inadequate prevention efforts in primary care.
Barriers	Collaborations and Surveillance System Challenges	Lack of coordination among healthcare providers, absence of a national renal disease registry, and inconsistent patient tracking.
Recommendations	Policy and Governance Reforms	Strengthen nephrology policies, increase funding, implement national strategies, and establish a renal disease registry.
Recommendations	Capacity Building and Education	Expand residency programs, provide structured training for healthcare professionals, and enhance nephrology education.
Recommendations	Public Awareness and Prevention Strategies	Integrate prevention programs in primary care, establish nephrology-specific clinics, and enhance public education on kidney disease management.