Objective  To observe the efficacy of roxadustat combined with erythropoietin (EPO) in the treatment of anemia in maintenance hemodialysis (MHD) patients with kidney transplant failure.  Method   A retrospective analysis was conducted on MHD patients with low EPO response and kidney transplant failure at Beijing Friendship Hospital affiliated to Capital Medical University during the period from June 2021 to December 2022. Some of the patients were treated with roxadustat combined with EPO. Changes of hemoglobin (Hb) and the compliance rate of Hb before and after the combination treatment were analyzed. Their physical and activity status were evaluated using the Eastern Cooperative Oncology Group (ECOG) scoring standards. The dosage of the two drugs and the adverse drug reactions were recorded.  Result  A total of 34 MHD patients with kidney transplant failure were enrolled in this study, including 23 cases in the combined roxadustat treatment group and 11 cases in the control group. There were no statistically differences in age, gender, dialysis age, dry weight and BMI between the two groups. In the combined roxadustat group, Hb increased from (97.91±15.47) g/L before treatment to (111.61±11.95) g/L after treatment (t=-4.499, P＜0.001); the HB level before treatment was lower than the HB level of 117.09±4.30g/L in the control group (t=-5.515, P＜0.001), but the HB level after the treatment had no statistical difference with the HB level of （117.09±4.30） g/L in the control group (t=-1.131, P=0.266); the compliance rate of Hb increased from 30.4% to 65.2% (χ2=7.265, P=0.017); and the ECOG scoring indicated that their physical and activity status improved (Z= -2.238, P=0.025). The dosage of roxadustat was 150mg/week in 16 patients and 300mg/week in 7 patients. In the combined roxadustat group, EPO dosage decreased from (14956.52±7351.43) U/week before the treatment to （7478.26±4066.15） U/week after the treatment (t=6.927, P＜0.001); the EPO dosage before treatment was higher than that of （10 727.27±2 412.09） U/week in the control group (t=2.493,P=0.018), but the EPO dosage after treatment was lower than that of （10727.27±2412.09） U/week in the control group (t=-3.290, P=0.002). No significant adverse reactions were observed in the combination therapy of roxadustat and EPO.  Conclusion  The combination therapy of roxadustat and EPO is safe and effective in MHD patients with lower EPO response and kidney transplant failure.