Readiness for telehealth integration in primary healthcare centers: a pilot mixed‑methods assessment from Lebanon's REMOTE project.

Chronic kidney disease (CKD) is an often asymptomatic and difficult-to-diagnose condition that may affect over two million children and adolescents worldwide []. Although CKD is less common in children than in adults, it presents as a complex and burdensome condition in the pediatric population, characterized by high treatment costs and potentially devastating outcomes []. The rising prevalence of CKD is a growing global concern, as the disease and its management can significantly impact both patients and their families—leading to impaired growth, reduced health-related quality of life (HRQoL), and increased risks of morbidity and mortality [, ]. CKD is defined as the presence of kidney damage and/or a sustained reduction in glomerular filtration rate (GFR) below 60 mL/min/1.73 m² for a duration of at least three months. This condition is typically associated with proteinuria, but may also be diagnosed based on pathological findings from renal biopsy or the detection of other markers of renal damage in urine, blood, or imaging studies []. CKD is categorized into five stages according to the level of glomerular dysfunction []. As CKD progresses from Stage 1 to Stage 5 (end-stage renal disease), there is a progressive decline in GFR and an increase in renal parenchymal damage []. During the early stages, conservative treatments focus on controlling risk factors to prevent progression to end-stage renal disease. Stage 5 CKD, defined by a GFR < 15 mL/min/1.73 m², represents kidney failure and necessitates renal replacement therapy, such as hemodialysis, peritoneal dialysis, or kidney transplantation []. As kidney function deteriorates with declining GFR, children and adolescents experience an increasing burden of symptoms and treatment demands. This decline has a profound negative impact on HRQoL and is associated with a level of psychosocial and functional impairment comparable to that seen in individuals with terminal malignancies [, ].