Relationship of Albuminuria and Renal Artery Stent Outcomes: Results from the FAIR Randomized Clinical Trial

Background: Atherosclerotic renal artery stenosis (ARAS) is the leading cause of secondary hypertension and associated with poor renal outcomes. Previous study suggest low albuminuria may identify those benefit from stent. We hypothesized fractional flow reserve (FFR)-guided stenting is better. Methods: The FAIR study is an investigator-initiated, multicenter, open-label, blinded endpoint RCT (NCT05732077). ARAS patients were randomized to FFR-guided or angiography-guided stenting. Hyperemic renal FFR was induced by dopamine and measured. Stenting was performed in the angiography-guided group regardless of FFR, however, in the FFR-guided group, only when FFR was <0.80. The primary endpoints was the change systolic blood pressure measured by 24-hour ambulatory at 3 months. Results: The baseline characteristics were similar (Table 1). There was a trend of continued reduction in ACR among those treated with stenting and FFR <0.80, while not in those with FFR ≥0.80 (Figure 1). Futhremore, regardless of the baseline ACR, continued blood pressure benefit was observed only among patients treated with stenting who had FFR <0.80 (Figure 2). Conclusion: Functional evaluation of ARAS with FFR might reduced albuminuria.Figure 1. The baseline characteristics, patient flow, and trend of urine albumin/creatinine ratio (ACR) from baseline up to 12 months post-procedure in different treatment groups.Figure 2. Change in daytime systolic blood pressure (A, C), diastolic blood pressure (B, D) from baseline up to 12 months in different baseline ACR groups.