Background: Anemia is a common complication of chronic kidney disease (CKD). Observational studies indicate that low Hb levels in such patients may increase risk for progression of kidney disease and cardiovascular morbidity and mortality. Objective: The aim of the work is to study the different risk factors contributing to anemia in preend stage renal disease patients (stage 3 and 4 CKD). Subjects and methods: The study involved 50 patients with history of CKD, not receiving any treatment or dialysis, 29 men and 21 women, 22-72 years old. In addition to 20 healthy persons as a control group. They were randomly selected from the outpatient clinics and inpatient department of Internal Medicine Departments, Al-Azhar Assiut University Hospitals over a period of two years. Results: There were different risk factors causing anemia among patients group; 1-Anorexia was present in (44%) of patients, 2-Fecal occult blood test was positive in (6%) of patients, 3-The indicators of inflammation including high levels of CRP, ESR (were high in 100%) and serum ferritin was high in (80%) of patients, 4-The indicators of “uremic milieu" including increased level of blood urea and S. creatinine and moderate to severe albuminuria in addition to decreased level of GFR, all were present in (100%) of patients, and 5-erythropoietin deficiency also was present in (54%) of patients. Conclusion: Our study concluded that anemia in pre end stage renal disease (ESRD) is multifactorial and the prevalence of different risk factors is inversely correlated with hemoglobin level.