<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.3 20210610//EN" "JATS-archivearticle1-3.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JPSIM</journal-id>
      <journal-title-group>
        <journal-title>Journal of Pakistan Society of Internal Medicine</journal-title>
        <abbrev-title>J Pak Soc Intern Med</abbrev-title>
      </journal-title-group>
      <issn publication-format="print">2709-8729</issn>
      <issn publication-format="electronic">2710-0804</issn>
      <publisher>
        <publisher-name>Pakistan Society of Internal Medicine</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.70302/jpsim.v6i2.2526</article-id>
      <article-id pub-id-type="publisher-id">jpsim.v6i2.2526</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Research</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Chronic Kidney Disease and Anemia: Exploring Patterns with Creatinine Clearance</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" corresp="yes">
          <name>
            <surname>Tanveer</surname>
            <given-names>Anam</given-names>
          </name>
          <email>anamtanveer42401@import.invalid</email>
          <xref ref-type="aff" rid="aff1"/>
          <xref ref-type="corresp" rid="cor1">*</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rauf</surname>
            <given-names>Muhammad Kamran</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Shahid</surname>
            <given-names>Fatima</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Anwar</surname>
            <given-names>Sidra</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <institution>Fatima Memorial Hospital, Lahore, Pakistan</institution>
      </aff>
      <author-notes>
        <corresp id="cor1">*Correspondence: Anam Tanveer (anamtanveer42401@import.invalid)</corresp>
      </author-notes>
      <pub-date date-type="pub" publication-format="electronic" iso-8601-date="2025-06-05">
        <day>05</day>
        <month>06</month>
        <year>2025</year>
      </pub-date>
      <pub-date date-type="collection" publication-format="electronic">
        <year>2025</year>
      </pub-date>
      <volume>6</volume>
      <issue>2</issue>
      <fpage>136</fpage>
      <lpage>140</lpage>
      <history>
        <date date-type="received" iso-8601-date="2024-07-22">
          <day>22</day>
          <month>07</month>
          <year>2024</year>
        </date>
        <date date-type="rev-recd" iso-8601-date="2025-01-01">
          <day>01</day>
          <month>01</month>
          <year>2025</year>
        </date>
        <date date-type="accepted" iso-8601-date="2025-04-24">
          <day>24</day>
          <month>04</month>
          <year>2025</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>Copyright © 2025 The Author(s)</copyright-statement>
        <copyright-year>2025</copyright-year>
        <copyright-holder>The Author(s)</copyright-holder>
        <ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/>
        <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
          <ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
          <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i2.2526" content-type="text/html"/>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i2.2526.pdf" content-type="application/pdf"/>
      <abstract>
        <sec>
          <title>Objective</title>
          <p>This study aims to determine the frequency and patterns of anemia in patients with chronic kidney disease (CKD) who have a creatinine clearance of less than 30 ml/min/1.73 m², in order to inform targeted treatment and reduce adverse outcomes.</p>
        </sec>
        <sec>
          <title>Methodology</title>
          <p>This six-month prospective study at Fatima Memorial Hospital, Lahore, enrolled 156 CKD patients aged 18-60 with a creatinine clearance</p>
        </sec>
        <sec>
          <title>Results</title>
          <p>The mean age of our study group was 47.2 ± 8.1years. The average age ranged between 38 and 45 years. Among these, 74.4% participants were males and 25.6% were females. All participants had anemia. The minimum mean hemoglobin level was 7g/dL and maximum were 11g/dL. 64.1% participants had normocytic normochromic anemia, 32.1% had iron deficiency anemia and 3.8% had combined deficiency anemia. These results confirmed the association of different patterns of anemia and CKD.</p>
        </sec>
        <sec>
          <title>Conclusion</title>
          <p>Present study highlights the prevalence and patterns of anemia in CKD patients with creatinine clearance below 30 ml/min/1.73m². Normocytic normochromic anemia was the most common pattern, followed by iron deficiency anemia and combined deficiency anemia. These findings underscore the multifactorial nature of anemia in CKD and its association with adverse outcomes such as cardiovascular complications and reduced quality of life.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en" kwd-group-type="author-keywords">
        <title>Keywords</title>
        <kwd>chronic kidney disease</kwd>
        <kwd>Iron deficiency anemia</kwd>
        <kwd>Normocytic normochromic</kwd>
        <kwd>Combined deficiency anemia</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <!-- <body> omitted: no manuscript (.docx) on file -->
  <back>
    <ref-list>
      <title>References</title>
      <ref id="ref1">
        <label>1</label>
        <mixed-citation>National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266.</mixed-citation>
      </ref>
      <ref id="ref2">
        <label>2</label>
        <mixed-citation>World Health Organization technical report series No. 405: nutritional anemias – report of a WHO Scientific Group. Geneva: WHO; 1968.</mixed-citation>
      </ref>
      <ref id="ref3">
        <label>3</label>
        <mixed-citation>Eschbach JW. The anemia of chronic renal failure: pathophysiology and the effects of recombinant erythropoietin. Kidney Int. 1989;35(1):134-48.</mixed-citation>
      </ref>
      <ref id="ref4">
        <label>4</label>
        <mixed-citation>Eckardt KU. Erythropoietin: oxygen-dependent control of erythropoiesis and its failure in renal disease. Nephron. 1994;67(1):7-23.</mixed-citation>
      </ref>
      <ref id="ref5">
        <label>5</label>
        <mixed-citation>Zadrazil J, Horak P. Pathophysiology of anemia in chronic kidney diseases: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):197-202.</mixed-citation>
      </ref>
      <ref id="ref6">
        <label>6</label>
        <mixed-citation>O'Mara NB. Anemia in patients with chronic kidney disease. Diabetes Spectr. 2008;21(1):12-9.</mixed-citation>
      </ref>
      <ref id="ref7">
        <label>7</label>
        <mixed-citation>Nalado AM, Mahlangu JN, Waziri B, Duarte R, Paget G, Olorunfemi G, Naicker S. Ethnic prevalence of anemia and predictors of anemia among chronic kidney disease patients at a tertiary hospital in Johannesburg, South Africa. Int J Nephrol Renovasc Dis. 2019; <pub-id pub-id-type="doi">10.2147/IJNRD.S179802</pub-id>.</mixed-citation>
      </ref>
      <ref id="ref8">
        <label>8</label>
        <mixed-citation>Ryu SR, Park SK, Jung JY, Kim YH, Oh YK, Yoo TH. The Prevalence and Management of Anemia in Chronic Kidney Disease Patients: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). J Korean Med Sci. 2017;32(2):249-56.</mixed-citation>
      </ref>
      <ref id="ref9">
        <label>9</label>
        <mixed-citation>Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med. 2002;162(12):1401-8.</mixed-citation>
      </ref>
      <ref id="ref10">
        <label>10</label>
        <mixed-citation>Miah OF, Hossain RM, Latif A, Sarkar U, Paul SK, Paul RS, Ahammod T, Islam MS, Dowel FA, Mahmud MA, Podder MK, Bhuiyan AS, Chowdhury UW. Pattern of Anaemia in Chronic Kidney Disease. Mymensingh Med J. 2019;28(1):1-7.</mixed-citation>
      </ref>
      <ref id="ref11">
        <label>11</label>
        <mixed-citation>Ullah K, Butt G, Masroor I, Kanwal K, Kifayat F. Epidemiology of chronic kidney disease in a Pakistani population. Saudi J Kidney Dis Transpl. 2015;26(6):1307-10.</mixed-citation>
      </ref>
      <ref id="ref12">
        <label>12</label>
        <mixed-citation>Dmitrieva O, de Lusignan S, Macdougall IC, Gallagher H, Tomson C, Harris K, et al. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol. 2013; <pub-id pub-id-type="doi">10.1186/1471-2369-14-24</pub-id>.</mixed-citation>
      </ref>
      <ref id="ref13">
        <label>13</label>
        <mixed-citation>Hasan M, Sutradhar I, Gupta RD, Sarker M. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol. 2018;19(1):291.</mixed-citation>
      </ref>
      <ref id="ref14">
        <label>14</label>
        <mixed-citation>Palaka E, Grandy S, van Haalen H, McEwan P, Darlington O. The Impact of CKD Anaemia on Patients: Incidence, Risk Factors, and Clinical Outcomes-A Systematic Literature Review. Int J Nephrol. 2020; <pub-id pub-id-type="doi">10.1155/2020/7692376</pub-id>.</mixed-citation>
      </ref>
      <ref id="ref15">
        <label>15</label>
        <mixed-citation>Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008; 35(2):329-44.</mixed-citation>
      </ref>
      <ref id="ref16">
        <label>16</label>
        <mixed-citation>Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008; <pub-id pub-id-type="doi">10.1186/1471-2458-8-117</pub-id>.</mixed-citation>
      </ref>
      <ref id="ref17">
        <label>17</label>
        <mixed-citation>Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019;<pub-id pub-id-type="doi">10.1007/978-981-13-8871-2_1</pub-id>.</mixed-citation>
      </ref>
      <ref id="ref18">
        <label>18</label>
        <mixed-citation>Lewandowski MJ, Krenn S, Kurnikowski A, Bretschneider P, Sattler M, Schwaiger E, et al. Chronic kidney disease is more prevalent among women but more men than women are under nephrological care : Analysis from six outpatient clinics in Austria 2019. Wien Klin Wochenschr. 2023;135(3-4):89-96.</mixed-citation>
      </ref>
      <ref id="ref19">
        <label>19</label>
        <mixed-citation>Rai NK, Wang Z, Drawz PE, Connett J, Murphy DP. CKD Progression Risk and Subsequent Cause of Death: A Population-Based Cohort Study. Kidney Med. 2023;5(4):100604.</mixed-citation>
      </ref>
      <ref id="ref20">
        <label>20</label>
        <mixed-citation>Zoccali C, Mallamaci F, Adamczak M, de Oliveira RB, Massy ZA, Sarafidis P, et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res. 2023; 119(11):2017-32.</mixed-citation>
      </ref>
      <ref id="ref21">
        <label>21</label>
        <mixed-citation>van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data. BMC Nephrol. 2020; 21(1):88.</mixed-citation>
      </ref>
      <ref id="ref22">
        <label>22</label>
        <mixed-citation>Vos FE, Schollum JB, Coulter CV, Doyle TC, Duffull SB, Walker RJ. Red blood cell survival in long-term dialysis patients. Am J Kidney Dis. 2011; 58(4):591-8.</mixed-citation>
      </ref>
      <ref id="ref23">
        <label>23</label>
        <mixed-citation>United States Renal Data System. CKD in the General Population. 2023 Annual Report. Available from: [https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-general-populationInternet ].</mixed-citation>
      </ref>
      <ref id="ref24">
        <label>24</label>
        <mixed-citation>Winearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM. Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet. 1986;2(8517):1175-8.</mixed-citation>
      </ref>
      <ref id="ref25">
        <label>25</label>
        <mixed-citation>Hanna RM, Streja E, Kalantar-Zadeh K. Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin. Adv Ther. 2021;38(1):52-75. =</mixed-citation>
      </ref>
      <ref id="ref26">
        <label>26</label>
        <mixed-citation>Shaikh H, Hashmi MF, Aeddula NR. Anemia of Chronic Renal Disease. In: StatPearls. [updated 2023 Feb 24] Available from: [ https://www.ncbi.nlm.nih.gov/books/NBK539871/ ].</mixed-citation>
      </ref>
      <ref id="ref27">
        <label>27</label>
        <mixed-citation>Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019; 133(1):40-50.</mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>
