〔Abstract〕 Objective To investigate the effects of roxadustat on anemia index and iron metabolism index in patients with maintenance hemodialysis, renal anemia and absolute iron deficiency. Methods Clinical data of patients with maintenance hemodialysis renal anemia combined with absolute iron deficiency treated in Yidu Central Hospital of Weifang from January 2021 to January 2023 were selected, and a total of 60 eligible patients were selected as research objects, and grouped according to the differences in treatment methods, that is, a control group and an observation group, with 30 cases each. Both groups were treated with polysaccharide iron complex, the control group was treated with recombinant human erythropoietin (rhEPO) on the basis of this treatment, and the observation group was treated with roxadustat, the course of treatment was 3 months. Anemia indexes, iron metabolism indexes and the occurrence of adverse reactions were compared between the two groups. Results After treatment, hemoglobin (Hb) level, red blood cell (RBC) count and hematocrit (Hct) in the two groups were higher than those before treatment, the differences were statistically significant (P < 0.05); but there was no significant difference between the observation group and the control group (P > 0.05). After treatment, the levels of serum iron (SI), serum ferritin (SF), total iron binding capacity (TIBC) and transferrin saturation (TSAT) in the two groups were higher than those before treatment; The levels of SI, TIBC and TSAT in the observation group were higher than those in the control group, and the SF level was lower than that in the control group, with statistical significance differences (P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Compared with rhEPO, roxadustat has more ideal therapeutic effect, high safety, and can effectively improve the anemia indexes and iron metabolism indexes of patients.