Objective: To investigate the effects of roxadustat on the microinflammatory response, nutritional status, and peritoneal solute transport capacity in peritoneal dialysis patients with renal anemia. Methods: A total of 90 peritoneal dialysis patients with renal anemia admitted to our hospital were enrolled from June 2022 to June 2025, and they were divided into two groups according to the treatment regimen: the recombinant human erythropoietin (rhEPO) group (treated with rhEPO alone, n=45) and the combined group (treated with rhEPO combined with roxadustat, n=45). After 12 weeks of treatment, anemia?related indicators, microinflammatory factors, nutritional status, and peritoneal solute transport function were compared between the two groups. Results: After treatment, the levels of hemoglobin and hematocrit in both groups were significantly increased compared with baseline (P＜0.05), and the combined group was significantly higher than the rhEPO group (P＜0.05). After treatment, the levels of albumin, prealbumin and transferrin in both groups were significantly higher than those before treatment in the same group (P＜0.05), and the combined group was significantly higher than the rhEPO group (P＜0.05). The serum levels of tumor necrosis factor?α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP) in both groups were significantly decreased after treatment (P＜0.05), and the combined group showed lower levels than the rhEPO group (P＜0.05). There were no significant changes in the 4-hour dialysate-to-plasma creatinine ratio (4h D/Pcr) before and after treatment in either group, and no significant differences were observed between the two groups (P＞0.05). Conclusion: Roxadustat can further correct the anemic state, improve nutritional status and regulate systemic microinflammation in peritoneal dialysis patients with renal anemia. Meanwhile, it exerts no obvious adverse effect on the rate of peritoneal solute transport, showing favorable overall clinical efficacy and safety.