A case of a middle-aged male patient on maintenance hemodialysis with a previously stable dialysis condition and clinically improved complications following treatment. This time, after exertion, the patient developed a rapidly progressing pneumonia, leading to respiratory failure and hypotension within two days. After three weeks of intensive anti-infective therapy, his clinical symptoms were alleviated, and his body temperature returned to normal. During this period, hemoglobin levels progressively decreased from 113 g/L to 65 g/L within one month. Despite routine treatment with EPO to correct anemia under the premise of active infection control, hemoglobin continued to decline. Following a switch to roxadustat (a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI)) treatment, hemoglobin increased by 16 g/L after four weeks and by 34 g/L after eight weeks, with anemia essentially corrected.