Acute kidney disease (AKD) is an important post-AKI phase during which patients remain vulnerable to incomplete kidney recovery, chronic kidney disease (CKD) progression, and kidney failure. However, standardized care models for AKD remain insufficiently established. The Intensified AKD Care to Reduce CKD (ISACC) trial evaluated whether a structured multidisciplinary team (MDT) program could improve kidney and survival outcomes compared with usual care among adults with AKD.

This prospective, randomized, open-label trial enrolled 261 adult patients with AKD stages 1–3. Participants were assigned to either MDT-based care (n=131) or standard care (n=130). The MDT intervention incorporated coordinated management by nephrologists, pharmacists, and dietitians. The primary endpoint was major adverse kidney events at 90 days (MAKE-90), defined as a composite of all-cause death, new renal replacement therapy (RRT), or persistent kidney dysfunction. Secondary endpoints included all-cause mortality, CKD progression, and long-term RRT requirement at 180 days and 1 year. Prespecified subgroup and interaction analyses were performed to explore whether baseline disease severity, AKD etiology, and comorbidities modified treatment response.

The incidence of MAKE-90 did not differ significantly between the MDT and standard-care groups (28.2% vs. 26.9%; HR 1.03; 95% CI, 0.65–1.64; p=0.92). However, MDT care was associated with a lower risk of CKD progression at both 180 days (21.4% vs. 35.4%; p=0.012) and 1 year (33.6% vs. 47.7%; p=0.028). Exploratory interaction analyses suggested that treatment response varied according to AKD stage and etiology. A significant interaction was observed for AKD stage, with MDT care associated with lower risk among patients with stage 3 AKD (HR 0.47; 95% CI, 0.26–0.87), whereas this benefit was not observed in stage 1 AKD. In addition, MDT care was associated with reduced long-term RRT requirement among non-diabetic patients (P for interaction=0.042) and patients without prior stroke (P for interaction=0.033).

In the ISACC randomized trial, structured MDT care did not reduce the overall incidence of MAKE-90 among patients with AKD. Nevertheless, the intervention was associated with slower CKD progression and a lower long-term need for RRT in selected patient groups. Further studies are warranted to refine risk-based selection strategies for post-AKI multidisciplinary care.