Background: Chronic kidney disease (CKD) is associated with significant alterations in mineral metabolism, particularly involving calcium and phosphorus. These changes can have profound effects on cardiovascular health, exacerbating conditions such as acute coronary syndrome (ACS). Understanding the levels of calcium and phosphorus in CKD patients presenting with ACS is crucial as these minerals can influence the severity of cardiovascular events, patient prognosis, and management strategies. Despite their potential impact, the precise role of calcium and phosphorus levels in the context of CKD and ACS remains underexplored. Aim: To investigate the relationship between calcium and phosphorus levels and clinical outcomes in chronic kidney disease patients presenting with acute coronary syndrome. Methods: This study was conducted on 150 CKD patients with and without dialysis who admitted to Zliten Medical Center, Zliten, Libya. Patients were divided into two groups: CKD without ACS group: 75 CKD patient with and without dialysis with no history of ACS and CKD with ACS group: 75 CKD patients with and without dialysis with chest pain consistent with Acute coronary syndrome (ACS). Calcium and Phosphorus were measured in all cases. Results:There was significant elevation in calcium and phosphorus levels in CKD with ACS group compared to those without ACS group. Conclusion: There are notable differences between CKD patients with and without ACS, and that calcium and phosphorus levels play a vital role in these patients.