Associations between serum JAML, nesfatin-1, and 25(OH)D and the risk of diabetic kidney disease in patients with type 2 diabetes

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 predictive 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 utilized, moreover, receiver operating characteristic (ROC) curves and the 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 occurrence, and an L-shaped association of serum nesfatin-1 or 25(OH)D with the risk of DKD. Multivariate logistic regression revealed that individuals in the highest tertile of serum JAML level had a significantly greater risk of developing DKD than those in the lowest tertile where confounders were controlled (JAML: OR 5.70, 95%CI 2.66–12.22, P < 0.001), in contrast, individuals in the highest tertile of serum nesfatin-1 or 25(OH)D had a significantly lower risk of DKD progression than those in the lowest tertile where confounders were controlled (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, with an optimal cutoff value of 289.47 pg/mL. 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 a predictive accuracy of 87.2% in predicting DKD in T2DM population. Elevated serum JAML levels whereas decreased serum nesfatin-1 and 25(OH)D levels were associated with a greater risk of DKD in patients with T2DM. A nomogram model based on this could more accurately predict the risk of DKD in individuals with T2DM.