Potential Health Benefits of Dietary Tree Nut and Peanut Enrichment in Kidney Transplant Recipients-An In-Depth Narrative Review and Considerations for Future Research

Abstract

Kidney transplant recipients face a substantial burden of premature mortality and morbidity, primarily due to persistent inflammation, cardiovascular risk, and nutritional deficiencies. Traditional nutritional interventions in this population have either focused on supplementing individual nutrients-often with limited efficacy-or required comprehensive dietary overhauls that compromise patient adherence. In this narrative review, we explore the rationale for dietary nut enrichment as a feasible, multi-nutrient strategy tailored to the needs of kidney transplant recipients. Nuts, including peanuts and tree nuts with no added salt, sugar, or oil, are rich in beneficial fats, proteins, vitamins, minerals, and bioactive compounds. We summarize the multiple post-transplant challenges-including obesity, sarcopenia, dyslipidemia, hypertension, immunological dysfunction, and chronic inflammation-and discuss how nut consumption may mitigate these issues through mechanisms involving improved micro-nutrient intake (e.g., magnesium, potassium, selenium), lipid profile modulation, endothelial function, immune support, and gut microbiota health. Additionally, we highlight the scarcity of randomized controlled trials in high-risk populations such as kidney transplant recipients and make the case for studying this group as a model for investigating the clinical efficacy of nuts as a nutritional intervention. We also consider practical aspects for future clinical trials, including the choice of study population, intervention design, duration, nut type, dosage, and primary outcome measures such as systemic inflammation. Finally, potential risks such as nut allergies and oxalate or mycotoxin exposure are addressed. Altogether, this review proposes dietary nut enrichment as a promising, simple, and sustainable multi-nutrient approach to support cardiometabolic and immune health in kidney transplant recipients, warranting formal investigation in clinical trials.

Keywords: aging; dietary intervention; fibrosis; inflammation; kidney transplant recipients; micro-nutrients; nuts; oxidative stress; very long-chain saturated fatty acids.

Figure 1

Overview of selected nutrients present in nuts that have suggested beneficial effects on cardiovascular risk, inflammation and the immune system in kidney transplant recipients. Abbreviations: B, boron; K, potassium; Mg, magnesium; Se, selenium; Zn, zinc.

Figure 2

Flow diagram of a parallel randomized controlled trial of mixed nut intervention in kidney transplant recipients.