The role of macrophages in peritoneal dialysis-associated peritoneal fibrosis

The peritoneum is the largest and most complex serous membrane in the body belonging to the category of semi-permeable membrane. Peritoneal dialysis, which is based on this principle, has become a primary treatment for patients with end-stage kidney disease. Compared to hemodialysis, peritoneal dialysis is not only simple to operate and less expensive, but also better at preserving residual kidney function. However, peritoneal dialysis-associated fibrosis has become the leading cause of peritoneal function loss and treatment withdrawal. Macrophages play a critical role in the pathogenesis of peritoneal fibrosis. Previous studies have shown that macrophages could affect peritoneal fibrosis through multiple mechanisms, including the activation of signaling pathways in peritoneal mesothelial cells that induce their phenotypic transformation (such as the CX3CL1-CX3CR1 pathway) with mesenchymal cells and the induction of epithelial-mesenchymal transition (EMT). This review summarizes the current understanding of the macrophage-peritoneal fibrosis relationship, providing new ideas for further molecular research, diagnosis, and treatment.