Introduction <p>Acute kidney injury following Myocardial infarction is serious complication linked to higher mortality and prolonged hospital stay. This study investigates incidence and risk factors of acute kidney injury, focusing on how the timing of patients’ presentation after symptom onset affects various risk factors.</p> Methodology <p>This cohort study was conducted among Myocardial infarction patients after obtaining IRC approval and written consent. All consecutive patients with a confirmed diagnosis of myocardial infarction were enrolled. Patients who declined consent or were transferred to another facility were excluded. Acute kidney injury was diagnosed according to KDIGO criteria and risk factors were evaluated using chi-square, relative risk and multivariate logistic regression using SPSS version 25.</p> Results <p>Among 131 patients with myocardial infarction, 54 (41.2%) developed acute kidney injury. Multivariate analysis identified older age (mean 60.9 ± 15.1 years, <i>p</i> = 0.002), longer symptom duration (mean 35.1 ± 8.3 hours, <i>p</i> &lt; 0.001), elevated random blood sugar (<i>p</i> = 0.036), reduced ejection fraction ( &lt; 40% in 37 [28.2%], <i>p</i> = 0.032), higher contrast volume (&gt;100 ml in 22 [16.8%], <i>p</i> &lt; 0.01), and diuretic use (38 [29.0%], <i>p</i> &lt; 0.001) as significant risk factors. Stratified analysis showed effect modification by timing of presentation: male sex was risk factor among early presenters ( &lt; 12 hours; <i>p</i> = 0.028), whereas diuretic use was significant among delayed presenters (≥12 hours; <i>p</i> = 0.004).</p> Conclusion <p>Acute kidney injury is a frequent, serious complication following Myocardial infarction, especially in settings with limited Percutaneous Coronary Intervention access that cause treatment delays. This study uniquely identifies effect modification of risk factor i.e. gender and diuretics use by timing of presentation. </p> Clinical trial number <p>Not applicable.</p>