We reported a 49-year-old male with malignant hypertension who developed acute renal failure. This condition also led to acute heart failure, microangiopathic hemolysis and thrombocytopenia. Additionally, the patient developed renal anemia. This is a typical case of cardiorenal anemia syndrome. Considering the pathogenesis of oxidative stress, inflammation, and iron metabolism disorders during the disease process, as well as the possibility that erythropoietins may further increase blood pressure, we prescribed roxadustat . After treatment and follow-up, the patient’s clinical parameters demonstrated significant improvement. Blood pressure normalized, cardiac function improved, and serum creatinine levels decreased from 797 μmol/L to a range of 170-190 μmol/L. Additionally, hemoglobin levels increased from 71 g/L to 129 g/L, platelet counts returned to normal, ferritin levels decreased from 755 ng/mL to 136 ng/mL, and transferrin saturation improved from 25% to 35%. This case suggests that roxadustat is one of the effective treatments for cardiorenal anemia syndrome.