Trends, Decomposition Analysis, and Future Predictions of the Burden of Ischemic Stroke Attributable to Kidney Dysfunction in China, 1990-2021: Based on the 2021 GBD Database

Objective Kidney dysfunction is a critical risk factor for ischemic stroke, yet longitudinal analyses of its burden in China remain limited. To evaluate the burden of Ischemic Stroke Attributable to Kidney Dysfunction (ISAKD) in China from 1990 to 2021, this study analyzed trends, gender and age differences, and decomposition of drivers and projected future trends up to 2040. Methods Utilizing the Global Burden of Disease 2021 database, deaths and disability-adjusted life years (DALYs) were analyzed. Joinpoint regression identified temporal trends, decomposition analysis quantified age, population, and epidemiological contributions, and Bayesian Age-Period-Cohort modeling projected future burden. Results From 1990 to 2021, deaths rose from 40,555 to 90,532 and DALYs from 947,578 to 1,875,486. The age-standardized DALY rate (ASDAR) dropped from 6.87 to 4.91 per 100,000, with an average annual percent change (AAPC) of -1.083. ASDAR fell from 129.90 to 92.67 per 100,000 (AAPC: -1.087%). Females had larger ASDR (6.41 to 3.97) and ASDAR (124.09 to 77.87) drops than males (ASDR: 7.65 to 6.38; ASDAR: 139.25 to 112.39). Burden peaked at 70–79, with males showing higher mortality (59.54 vs. 41.97 per 100,000) at 75–79. Decomposition revealed that aging (84.62%) and population growth (67.58%) drove mortality, offset by epidemiology (-52.2%). Aging (278.11%) and epidemiology (132.61%) raised DALYs, while population growth (-310.72%) diminished DALY losses. By 2040, ASDR is projected to fall to 6.90 and ASDAR to 144.35 per 100,000. Conclusions: Though absolute burden increased, ASDR and ASDAR fell, with females exhibiting greater declines than males, reflecting gender differences. The 70–79 age group faced the highest burden. Decomposition shows that aging markedly boosts mortality and DALYs, while population growth raises mortality but cuts DALY losses, and epidemiology curbs mortality yet raises DALY losses. Forecasts of ongoing declines highlight the need for age- and sex-specific interventions.