Coronary artery disease (CAD) and chronic kidney disease (CKD) frequently coexist, particularly in elderly populations. Their coexistence increases cardiovascular morbidity and mortality due to complex pathophysiological interactions such as accelerated atherosclerosis, endothelial dysfunction, oxidative stress, and disturbances in water-electrolyte balance. This study aims to optimize percutaneous coronary intervention (PCI) outcomes in patients with CAD and CKD by evaluating diagnostic approaches, procedural strategies, and peri-procedural management. We retrospectively analyzed 100 patients with CAD and CKD who underwent PCI between 2022 and 2024 at the Republican Specialized Scientific-Practical Medical Center of Surgery named after acad. V. Vakhidov. Data included demographics, CKD stage distribution, procedural details, and short-term outcomes. The majority of patients (46%) were in CKD stage 3, with a mean age of 64 years. PCI was associated with a high procedural success rate (>95%), while contrast-induced nephropathy (CIN) occurred in 9% of cases, predominantly in advanced CKD stages. Conclusion: Optimizing PCI in CKD patients requires a multidisciplinary approach, minimization of contrast volume, and close monitoring of renal function. Our findings support the integration of nephrology and cardiology expertise to improve outcomes in this high-risk group