Objective To compare the influence of roxadustat on hemoglobin and its variability in the patients undergoing hemo-dialysis at different age and to observe the adverse reactions. Methods A retrospective cohort analysis was made of the clinical data of 55 patients with low responsiveness to erythropoietin in maintenance hemodialysis in the Beijing Aerospace General Hospital from July 2019 to October 2020. The patients were divided into two age groups:the elderly group (n=28; age>60 years) and the non-elderly group (n=27; age<60 years). Roxadustat was administered for 6 months according to body mass. No iron was used in either group. Hemoglobin (Hb), serum ferritin (SF) and transferrin saturation, the triglyceride and total cholesterol (TC) were tested before and 6 months after roxadustat administration. The hemoglobin variability (Hb-Var) and the adverse events were recorded. SPSS statistics 25.0 was used for statistical analysis. Comparison between two groups was performed using t-test or χ² test depending on data type. Results Hb before and after the treatment differed significantly in both the elderly group [(100.20±14.26) vs (114.47±7.70) g/L] and the non-elderly group [(96.05±11.45) vs (112.42±14.60) g/L] respectively. Hb-Var was lower in the elderly group [(8.84 ± 4.13) g/L] than in the non-elderly group [(12.47 ± 3.87) g/L] ( P<0.05). SF decreased significantly after 6 months of treatment in the elderly group [(947.0±715.6) vs (694.3±369.9) ng/ml] and in the non-elderly group [(850.9±668.6) vs (640.6±174.4) ng/ml] (P<0.05 for both). After treatment, TC decreased significantly in the elderly group [(3.98±1.01) vs (3.45±0.61) mmol/L] and in the non-elderly group [(3.61±0.66) vs (3.26±0.80) mmol/L] (P<0.05 for both). There were no significant differences in other indexes (P>0.05). The incidence of adverse events was 14.28% (4/28) in the elderly group and 11.11% (3/27) in the non-elderly group, and the difference was not statistically significant (P>0.05). Conclusion Roxadustat can increase Hb in the hemodialysis patients with low responsiveness to recombinant human erythropoietin, the responses to roxadustat in patients at different age are various, especially in non-elderly group. Roxadustat can significantly increase the utilization rate of iron and decrease TC.