Fatty acid metabolism: opportunities and challenges of traditional Chinese medicine in the treatment of renal fibrosis

Renal fibrosis (RF), as a critical pathological process in the progression of chronic kidney disease (CKD) to end-stage renal disease, currently lacks clear and effective reversal measures. Disordered fatty acid metabolism is highly involved in this process. Studies have revealed that molecular crosstalk under fatty acid metabolism dysregulation-such as lipotoxicity, mitochondrial damage, immune inflammation, epigenetics, metabolic reprogramming, and the gut-kidney axis-drives damage to renal tubules, glomeruli, and the interstitium. Therapeutic strategies targeting fatty acid metabolism to ameliorate RF have gradually become a research hotspot, though most current drugs are still in the clinical exploration stage, and the predictive and therapeutic value of many biomarkers remains to be validated. Traditional Chinese Medicine (TCM), with its personalized and modernized approach combining oral administration and external treatments such as acupuncture, enema, and nanodelivery, is increasingly demonstrating advantages in targeting fatty acid metabolism to improve RF. This review outlines the mechanisms and core targets of TCM in regulating fatty acid metabolism to ameliorate RF. The multi-target advantage based on complex components presents an opportunity for TCM to improve RF, though current research still faces challenges such as mechanistic complexity, standardization of TCM, and clinical translation. Future efforts should integrate multi-omics technologies, novel drug delivery systems, and disease-syndrome combination models to advance the development of new integrated Chinese and Western medicine drugs for RF.