Abstract: Background: Patients with advanced chronic kidney disease (CKD), subjected to hemodialysis (H.D.), may not manifest chest pain with severe coronary artery disease (CAD). Aim of the study: Study the value of radionuclide myocardial perfusion using gated single-photon emission tomography (gSPECT) in recognition of the frequency and risk factors of CAD in different stages of CKD patients. Patients and methods: the current study divided 133 CKD patients (pts) into three groups according to CKD stage: 43 cases in stage 3, 43 in stage 4, and 47 in stage 5. Each stage included asymptomatic and symptomatic subgroups. The present study recorded the clinical evaluation, laboratory data (in the form of complete blood picture, fasting blood glucose and glycosylated hemoglobin (HbA1c), lipid profile, serum calcium and phosphorus, C-reactive protein [CRP]), together with imaging tests (Dipyridamole stress-rest gSPECT/C.T., coronary C.T. angiography and LVM index by echocardiography) for all patients. Results: the study included ninety-nine asymptomatic and 34 symptomatic patients. CKD 3 included 33 asymptomatic and ten symptomatic, CKD 4 included 33, and 10, while CKD5 included 33 and 14, respectively. The asymptomatic group presented forty-eight cases (48.5%) abnormal gSPECT (19 fixed and 29 reversible defects). Eleven of this abnormal gSPECT were in CKD3, thirteen in CKD 4, and twenty-four in CKD 5, with a statistically higher prevalence of abnormality in CKD5 (P 4) was dependent first of all on age, which consequently revealed the substantial role of D.M., LVH, and elevated CRP. Conclusion: stress-rest gSPECT is essential in the revealing of CAD in different stages of CKD, even in low-risk patients. High-risk CKD patients for CAD are those with D.M., LVH, and high CRP.