The lube is at risk here. Fuel is the number one issue, and as Charlie noted the TBN could be cause for alarm, but we'd really need to know TAN as well to understand how far it may or may not have turned.
However, the engine itself is fine. There's not any real metal count indicating that the lube has allowed any detrimental effect. Seems that Fe and Al are in line with reasonable wear rates, and the others (Pb, Cu, Cr and Ni) are all fine. Despite a generally fuel rich and EGR rich condition, the engine is handling it well. Si is low and has stayed that way; no concern there.
What this UOA shows is that there is not a direct, but indirect relationship between the lube and the engine. The lube is at risk; it should be monitored and controlled. The engine, however, seems unphased by the general state of the lube. There's nothing from the engine's point of view that screams at you. This is a great example of how cautionary notes do not always result in actual effect. If you were to use the lubes in ever increasing OCIs, then I would expect at some point to see wear rates affected. But at this point, you've not reached that the apex yet.
Just because you don't short trip or idle a great deal, that does not mean you're not also getting a lot of regen cycles. These newer diesels need to be operated under heavy load, often, to keep the EGT up, which in turn burns cleaner in the cyls and DPF. If you are running with little to no load, then you're not generating a lot of EGT, and so the regens will be more frequent. That would at least partially explain the fuel, etc. I cannot assure you this is the case, but it is a potential cause. More understanding of your actual loading and use of the truck would help here.
I would recommend, if simplicity is your goal, simply following the IOLM and continued monitoring for a while.
Also, your thread title shows 15w-40, but the report shows 5w-40 (as does your sig line). Which is it in this report? If you're actually running the syn, you might consider switching back to the conventional lube; longer OCIs are not likely to be pragmatic and therefore you could be saving money.