Abstract
Background: Kidney transplantation is the most effective treatment for patients with end-stage
kidney disease. However, kidney transplant recipients remain at a higher risk of cardiovascular
disease than the general population, which represents a major cause of mortality. Hypertension
is a modifiable risk factor. Evidence from the general population suggests that a plant-based
diet can reduce blood pressure and improve gut microbiota composition; however, data in
kidney transplant recipients are limited. This study aims to evaluate the effects of a plant-based
dietary pattern on blood pressure levels and changes in gut microbiota among kidney transplant
recipients.
Methods: We conducted a randomized controlled trial in kidney transplant recipients with
stable allograft function at Ramathibodi Hospital. A total of 102 participants were randomized
into two groups: a plant-based, low-sodium diet group and a control group, and were followed
for 12 weeks. The primary outcome was the change in blood pressure, while the secondary
outcomes included changes in gut microbiota, allograft function, and quality of life.
Results: After 12 weeks of follow-up, there were no significant changes in systolic blood
pressure (mean difference −2.00 mmHg; 95% CI −6.65 to 2.65; p = 0.40) or diastolic blood
pressure (−2.84 mmHg; 95% CI −5.91 to 0.22; p = 0.07) between groups; however, a favorable
trend toward improvement was observed in the plant-based, low-sodium diet group. This group
demonstrated a significant reduction in total cholesterol and LDL cholesterol (195.90 ± 5.18 to
173.06 ± 5.27 mg/dl and 123.96 ± 4.81 to 102.07 ± 4.90 mg/dl, respectively). Body weight also
decreased significantly, which was attributed to a reduction in fat mass, while muscle mass
remained unchanged. No adverse effects on allograft function or quality of life were observed.
Alpha diversity increased significantly in both groups. Notably, in participants adhering to the
plant-based, low-sodium diet, Bacteroides thetaiotaomicron and Parasutterella
excrementihominis emerged as dominant taxa at week 12 compared with baseline.
Conclusions: A plant-based, low-sodium diet is safe and confers metabolic benefits, particularly
by improving lipid profiles, among kidney transplant recipients. Moreover, it shows a favorable
trend toward better blood pressure control.
