We reported a 40-year-old man with a history of chronic hepatitis B virus, without cirrhosis and splenomegaly, who is HBsAg, HBeAg and anti-HBc positive. He has been undergoing hemodialysis treatments three times weekly through the left forearm arteriovenous fistula for 5 years, supported by symptomatic supportive treatments to promote hematopoiesis, control his blood pressure and regulate his calcium and phosphorus metabolism. However, his anemia was not well corrected. This patient was given a high dose of erythropoietin 10,000 iu BIW, but his hemoglobin still fluctuated between 70 and 80 g/L. We considered the possibility that he had an iron metabolism disorder, a microinflammatory state, and that erythropoietin resistance could be related to the status of chronic hepatitis B. We adjusted the hematopoietic stimulation plan to 100 mg roxadustat TIW. Thereafter, he had a gradual increase in hemoglobin to 90 g/L. We monitored the gradual increase in hemoglobin to a stable and normal state. Iron metabolism was improved significantly compared to before, with an increase in serum iron and transferrin saturation, a decrease in ferritin, and an increase in iron utilization.