Abstract
Strongyloides stercoralis infection poses significant risks to individuals with suppressed immune systems, including patients with chronic kidney disease (CKD). However, data on its prevalence in this population, particularly in Southeast Asia, remains scarce. This study aimed to determine the seroprevalence using two assays, as well as to describe its epidemiological characteristics and associated laboratory parameters among patients with advanced CKD at a tertiary hospital in Kuala Lumpur, Malaysia. A total of 220 patients with stages 4 and 5 CKD were recruited. Serum samples were screened using a commercial IgG-ELISA (Bordier) and an IgG4-based rapid diagnostic test (IgG4-RDT). Epidemiological and clinical data were collected through structured interviews and medical records. The overall S. stercoralis seroprevalence was 44 %, with 41.8 % detected by IgG4-RDT and 6.8 % by IgG-ELISA, showing only slight agreement (κ = 0.2). These findings suggest that, despite the impaired humoral immunity typically observed in advanced CKD patients, specific IgG4 responses remain sufficiently detectable. It may reflect both a relatively preserved IgG4 response and the higher sensitivity of the IgG4-based assay in this population. No significant associations were found between seropositivity and demographic, socioeconomic, lifestyle, or laboratory parameters. However, cough was significantly associated with seropositivity. The results highlight a potentially underrecognized burden of Strongyloides infection among Malaysian CKD patients. Incorporating serological screening, particularly with the IgG4-RDT, into nephrology care may facilitate early detection and better management. Future studies are warranted to assess treatment outcomes and preventive strategies, including ivermectin prophylaxis.