We present a case study of a 44-year-old female patient who has been suffering from longstanding diabetes mellitus, hypertension, and chronic kidney disease (CKD). She was hospitalized due to persistent fatigue and proteinuria over a four-year period. Initially, the patient received treatment for renal anemia with subcutaneous injections of recombinant human erythropoietin (rHuEPO) and oral supplementation of a polysaccharide iron complex. However, as the disease progressed, the need for maintenance hemodialysis became apparent. Microinflammatory states are common in patients treated with dialysis. Despite the presence of a microinflammatory state, the patient showed a suboptimal response to rHuEPO therapy. Roxadustat was introduced in the treatment regimen. This agent is capable of globally regulating erythropoiesis, irrespective of the presence of microinflammation. Its mechanisms of action include modulation of inflammatory cytokines, enhancement of iron utilization efficiency, alteration of the gut microbiome, and attenuation of erythropoietin resistance. Following the initiation of roxadustat, the patient demonstrated a significant increase in hemoglobin levels, which were subsequently maintained within a stable range.