Fatores neurotróficos e marcadores inflamatórios em crianças e adolescentes com doença renal crônica: associação com sintomas depressivos e ansiosos, resiliência e qualidade de vida

Abstract

Background: Inflammatory markers and neurotrophic factors have been associated with psychiatric symptoms in the general population. In studies with chronic diseases, including renal disease (CKD), a proinflammatory profile is related to psychiatric morbidity and worsening of the prognosis. Behavioral changes have been reported in children and adolescents with CKD, negatively influencing their quality of life, but its relationship with neurotrophic factors and inflammatory markers is still unknown. Objective: To evaluate neurotrophic and inflammatory factors in children and adolescents with CKD in comparison to controls, and its association with psychiatric symptoms, resilience and quality of life. Methods: Demographic and clinical data were collected from 34 children and adolescents with CKD and 108 healthy controls. Participants were evaluated with Wagnild and Young Resilience Scale, Pediatric Quality of Life (QoL) Inventory 4.0 (PedsQLTM), Child Depression Inventory (CDI) and Self-report for Childhood Anxiety Related Disorders (SCARED) scales. Neurotrophic factors, chemokines, cytokines and adipokines were measured in 34 controls and patients with CKD. Results: Children and adolescents with CKD had higher frequency of delayed educational attainment, lower overall QoL scores, as well as poorer scores in the physical and psychosocial subdomains of QoL instruments. There was no difference between the ocurrence of clinically significant depressive or anxiety symptoms, but patients had higher scores of separation anxiety. Lower scores of resilience and quality of life were independent predictors of depressive symptoms in this group. Reduced BDNF and CXCL8/IL-8 concentrations and increased sTNFR1 and sTNFR2, resistin, adiponectin, CCL2/MCP-1, CXCL-9/MIG and CCL5/RANTES were identified in CKD patients in comparison to controls. Among patients with clinically significant anxiety symptoms, lower values of NGF, GDNF, NT3, NT4/5 and IL-33/ST2 were observed, but only NGF and CDI scores, age, and glomerular filtration rate remained as independent predictors in multivariate analysis. Conclusion: Children and adolescents with CKD exhibited an altered profile of neurotrophic factors and inflammatory biomarkers, as well as lower scores of quality of life and more symptoms of separation anxiety. Lower scores of resilience and quality of life were independent predictors of depressive symptoms.