ABSTRACT Hemodialysis (HD) patients often suffer from poor quality of life (QoL), malnutrition, and chronic inflammation. This study aimed to examine how plant‐based diet index (PDI) affects serum pentraxin‐3 (PTX3) levels (an inflammation marker), handgrip strength (HGS), and QoL in these patients. This cross‐sectional study was conducted on 321 HD patients from six medical centers in Isfahan, Iran. PDI was assessed using a 168‐item food frequency questionnaire. PTX3 levels were measured through the enzyme‐linked immunosorbent assay (ELISA). HGS was assessed using a dynamometer. QoL was evaluated using the Kidney Disease Quality of Life‐Short Form (KDQOL‐SF) questionnaire. Statistical data analysis included binary logistic regression and was adjusted for various confounders. HD Patients in the highest PDI tertile had significantly lower risk of high PTX3 levels (OR: 0.38, CI, 0.16–0.90) as well as lower risk of low HGS (OR: 0.43, CI, 0.19–0.94) compared to the lowest PDI tertile. Males with higher PDI scores also had significantly lower risk of low QoL (OR: 0.42, CI, 0.18–0.98), though no significant association was observed in females. Adherence to a plant‐based diet was associated with reduced inflammation, improved physical strength, and better QoL, particularly in male HD patients. A plant‐based diet may offer health benefits for HD patients, but further studies are needed to establish causality.