| Summary: | ABSTRACT Anemia is the most common complication of end‐stage renal disease (ESRD). While erythropoiesis‐stimulating agents (ESA) have improved treatment outcomes, some patients exhibit intolerance or hyporesponsiveness. Roxadustat, a hypoxia‐inducible factor prolyl hydroxylase inhibitor (HIF‐PHI), improves erythropoiesis and iron metabolism, offering advantages in ESA‐refractory cases. However, its use in pediatric populations remains limited. We present a case of a 13‐year‐old girl on maintenance hemodialysis who exhibited both hyporesponsiveness and intolerance to ESA. Initiation of oral Roxadustat resulted in a sustained improvement in hemoglobin levels, accompanied by notable enhancements in iron metabolism and clinical symptoms. So far, over 5 years of follow‐up, no significant adverse events were observed. Oral Roxadustat appears to be an effective and safe treatment option for teenage hemodialysis patients who are resistant or intolerant to ESA.
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