Abstract Body (Do not enter title and authors here): Background
Ischemic heart disease is a significant cause of mortality among adult patients suffering from chronic renal failure in the United States. This study investigates trends in ischemic heart disease-related mortality in adults aged 25 and older with chronic renal failure, focusing on overall and gender-related trends.

Methods
A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

Results
Ischemic heart disease in patients with chronic renal failure accounted for 552171 deaths among US adults aged 25+. Most deaths occurred at a medical facility (45.30%) and the patient’s home (19.90%). The overall AAMR for Ischemic Heart Disease in CRF-related deaths decreased from 13.1 in 1999 to 10.8 in 2020, with an AAPC of -1.1378 (95 % CI: -4.1816 to 2.0028, p = 0.473276). It is worth noting from 2015 to 2020 the APC has been 6.1116 (95 % CI: 2.1479 to 10.2291, p = 0.005627). Males had higher AAMRs (16.9) compared to females (8.1). Over the years, there was a decrease in both males with an AAPC of -1.3131 (95% CI: -1.3131 to -2.6983, p = 0.065243) and females with an AAPC of -1.8078 (95% CI: -5.1342 to 1.6353, p = 0.299506). Interestingly, from 2015 to 2020 the APC for females was 6.2678 (95% CI: 1.7801 to 10.953, p = 0.010085).

Conclusion
Overall, there has been a notable decline in CKD and Ischemic Heart Disease (IHD)-replated mortality from 1999 to 2020 however from 2015 to 2020 there has been an increase in IHD-related deaths amongst patients with CKD. Gender stratification of this data shows that the overall mortality burden is higher in males than in females. The overall mortality from 1999 to 2020 has decreased in both genders however from 2015 to 2020 the mortality has been increasing in the female population which might be driving the overall increase in mortality. We believe that the increasing mortality due to CKD and IHD-related deaths in recent years (2015 to 2020) is alarming and should be addressed via policymaking and increased awareness. The higher overall burden in males and the increasing mortality in females in recent years also need to be addressed.