Abstract
This study was designed to assess the associations between serum junctional adhesion molecule-like protein (JAML), nesfatin-1, and 25-hydroxy vitamin D (25(OH)D) and the incidence of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), as well as to explore their risk assessment value in DKD. Serum JAML, nesfatin-1, and 25(OH)D levels were measured in 227 patients with T2DM. All participants were categorized into tertiles based on their serum JAML, nesfatin-1, and 25(OH)D levels. For statistical analysis, multivariate logistic regression models and restricted cubic splines (RCS) were employed; additionally, receiver operating characteristic (ROC) curves and a nomogram were developed. Of the 227 patients with T2DM, 114 (50.2%) were diagnosed with DKD. The RCS analysis showed an S-shaped association between the serum JAML and DKD incidence and an L-shaped association of serum nesfatin-1 or 25(OH)D with the risk of DKD. Multivariate logistic regression revealed that, after controlling for confounders, individuals in the highest tertile of serum JAML level had a significantly greater risk of developing DKD than those in the lowest tertile (JAML: OR 5.70, 95% CI 2.66-12.22, P < 0.001). Conversely, those in the highest tertile of serum nesfatin-1 and 25(OH)D exhibited significantly reduced risks of DKD progression compared to those in the lowest tertile (nesfatin-1: OR 0.21, 95% CI 0.10-0.44, P < 0.001; 25(OH)D: OR 0.19, 95% CI 0.08-0.45, P < 0.001). The ROC curves showed that the serum JAML levels were better than nesfatin-1 or 25(OH)D at predicting DKD. Finally, a nomogram model based on the above three indicators combined with a history of hypertension, course of diabetes, and history of diabetic complications of retinopathy achieved 87.2% accuracy in assessing risk of DKD in patients with T2DM. Elevated serum JAML levels coupled with reduced nesfatin-1 and 25(OH)D concentrations were significantly associated with increased risk of DKD in patients with T2DM. The nomogram integrating these biomarkers demonstrated quantifiable advantages in risk assessment of DKD.