Diabetes Mellitus Complicated by Renal Failure: Burden in a 3.30-Million Resident Cohort in Pudong New Area, Shanghai, China

Background Diabetes mellitus complicated by renal failure (DM-RF) is an emerging driver of premature death in China. Objective To quantify 19-year mortality trends attributable to DM-RF in Pudong New Area of Shanghai and to project the burden to 2035. Methods Using population-based vital-registration data covering 3.30 million residents (2005–2023), we calculated crude mortality, world-standardized age-standardized mortality rates (ASMRW), years-of-life-lost (YLL) rates and average YLL (AYLL). Decomposition analysis identified key drivers; Bayesian age–period–cohort models forecast rates for 2024–2035. Results Over the study period, 3,699 DM-RF deaths were documented. ASMRW more than tripled, rising from 1.29 to 4.15 per 100,000 (average annual percentage change 6.89%). Males consistently experienced higher mortality than females, with ASMRW of 5.44 vs 2.94 per 100,000 in 2023. The YLL rate increased by 8.64% annually, whereas AYLL declined modestly (− 0.62%; all P  < 0.001). Epidemiological factors explained 311% of the 376 excess deaths, with males accounting for 521%. Bayesian projections estimated that ASMRW will reach 6.06 (95% CI: 3.77–8.35) per 100,000 by 2035. Conclusion DM-RF mortality is escalating rapidly in Pudong New Area of Shanghai, propelled by deteriorating glycaemic control and population aging. Sex-specific, age-targeted and community-integrated prevention strategies are urgently needed if Shanghai is to meet Sustainable Development Goal 3.4.