Inflammation facilitates the occurrence and progression of anemia in chronic kidney disease (CKD) through multiple pathways. Moreover, the efficacy of erythropoiesis-stimulating agents (ESAs) is diminished in an inflammatory state, further complicating the correction of anemia in CKD patients. This case report focuses on a middle-aged male patient diagnosed with systemic lupus erythematosus (SLE), lupus nephritis, and stage 5 chronic kidney disease. The patient had a complex medical history involving peritoneal dialysis and hemodialysis due to renal failure and recurrent peritonitis. Before hospitalization, he experienced another episode of abdominal pain and was diagnosed with peritonitis. Following appropriate antibiotic therapy and surgical intervention, his peritonitis was successfully controlled. However, despite administration of a high dose of ESA (r-HuEPO 20,000 U/week), the patient’s anemia remained uncorrected (hemoglobin level 71 g/L). Subsequently, we transitioned the treatment to roxadustat. Initially, the patient received roxadustat at a dose of 120 mg three times a week, which resulted in a rapid increase in hemoglobin levels (128 g/L) within three months. During follow-up, the roxadustat dose was adjusted to 100 mg three times a week based on the patient’s hemoglobin levels. The patient’s anemia was effectively corrected and the hemoglobin level maintained stable. This indicates that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) may offer a promising and effective solution for managing renal anemia in patients with inflammation, providing valuable insights for clinical practice.